654-27679-59350
3 vaccinations
4 coded responses
26 check-ins
4 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 208 / MD
- Registered
- 2021-02-16
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-16
Registered in v-safe
-
2021-02-16
Dose 1 — Moderna
- 2021-02-16
- 2021-02-17
- 2021-02-18
- 2021-02-19
-
2021-02-20
Survey response — days 1–6 daily, dose 1MedDRA: Fatigue — Feeling: Good · Fatigue or tirednessFree text: Fatigue but probably unrelated to vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-21
- 2021-02-22
- 2021-02-23
- 2021-03-02
- 2021-03-09
-
2021-03-16
Dose 2 — Moderna
- 2021-03-16
-
2021-03-17
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-03-18
- 2021-03-19
-
2021-03-20
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue, Nasopharyngitis, Respiratory tract congestion, Rheumatoid arthritis — Feeling: Poor · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: I am virtually certain I picked up a head cold from my adult daughter who lives here. Congestion and fatigue since Fri 3/19. Like her four days earlier. She tested negative for covid last Monday. I take methotrexate for RA. I dont think this is a vaccine side effect. (b)(6)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-21
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
-
2021-03-22
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue, Nasopharyngitis — Feeling: Fair · Fatigue or tirednessFree text: Still have a head cold causing fatigue. No vaccine side effects left as best I can tell.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-23
-
2021-03-30
Survey response — day 14, dose 2MedDRA: Fatigue, Nasopharyngitis, Pyrexia, SARS-CoV-2 test negative — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Severe head cold, fatigue,fever of 101.3 · Healthcare visit (other): Had covid test too on 3/26. Negative.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-30
Report sent to call center — day 14, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-06
- 2021-04-13
- 2021-04-20
- 2021-04-27
- 2021-06-15
-
2021-08-23
Dose 3 — Moderna
- 2021-09-16
- 2021-11-22
-
2022-01-22
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-16 | Moderna | |
| 2 | 2021-03-16 | Moderna | |
| 3 | 2021-08-23 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Fatigue but probably unrelated to vaccine.
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): I am virtually certain I picked up a head cold from my adult daughter who lives here. Congestion and fatigue since Fri 3/19. Like her four days earlier. She tested negative for covid last Monday. I take methotrexate for RA. I dont think this is a vaccine side effect. (b)(6)
redacted (b)(6)
Systemic reaction (other): Still have a head cold causing fatigue. No vaccine side effects left as best I can tell.
Release 6 — day 14, dose 2
Symptoms: Severe head cold, fatigue,fever of 101.3
Healthcare visit (other): Had covid test too on 3/26. Negative.
Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".
MedDRA terms by release
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| HCVO | SARS-CoV-2 test negative | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Nasopharyngitis | ✓ | ✓ | ✓ |
| SRO | Respiratory tract congestion | ✓ | ✓ | ✓ |
| SRO | Rheumatoid arthritis | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release