66Q-15235-99107
5 vaccinations
14 coded responses
70 check-ins
14 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 921 / CA
- Registered
- 2021-01-25
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-25
Registered in v-safe
-
2021-01-25
Dose 1 — Moderna
- 2021-01-25
-
2021-01-26
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
-
2021-01-27
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fever · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-01-28
- 2021-01-29
- 2021-01-30
- 2021-01-31
- 2021-02-01
- 2021-02-08
- 2021-02-15
-
2021-02-22
Survey response — day 28, dose 1MedDRA: Arthralgia, Asthenia, Diarrhoea, Pyrexia — Feeling: GoodFree text: Weakness, joint pain, 101.6 fever, diarrhea.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-23
Dose 2 — Moderna
- 2021-02-23
-
2021-02-24
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, NauseaAdult check-in
-
2021-02-25
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fever · Headache, Muscle or body achesAdult check-in
-
2021-02-26
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fever · Fatigue or tirednessAdult check-in
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-09
-
2021-03-16
Survey response — day 21, dose 2MedDRA: Cough — Feeling: GoodFree text: CoughMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-23
- 2021-03-30
-
2021-04-06
Survey response — day 42, dose 2MedDRA: Back pain — Feeling: Good · Be unable to do your normal daily activitiesFree text: Lower back painMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-25
Survey response — 3 months, dose 2MedDRA: Pain in extremity — Feeling: Good · Be unable to do your normal daily activitiesFree text: Pain in the left foot for a couple of weeks. Improving now.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-08-25
Survey response — 6 months, dose 2MedDRA: Pain in extremity — Feeling: GoodFree text: Pain in left foot.MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-10-27
Dose 3 — Moderna
- 2021-10-27
-
2021-10-28
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-10-29
Health check-in — days 1–6 daily, dose 3Feeling: Good · Fever · Joint pains, Muscle or body achesAdult check-in
- 2021-10-30
-
2021-10-31
Survey response — days 1–6 daily, dose 3MedDRA: Night sweats — Feeling: Good · Fever · Joint pains, Muscle or body achesFree text: Night sweatsMedDRA releases: 2024-11 · check-in free text available
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-10
-
2021-11-17
Survey response — day 21, dose 3MedDRA: Conjunctivitis — Feeling: GoodFree text: Pink eyeMedDRA releases: 2024-11 · check-in free text available
-
2021-11-24
Survey response — day 28, dose 3MedDRA: Unevaluable event, Uveitis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Symptoms: Uveitis with possible herpes zoster in right eye · Healthcare visit (other): Referral to opthalmology departmentMedDRA releases: 2024-11 · check-in free text available
-
2021-11-24
Report sent to call center — day 28, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2021-12-01
- 2021-12-08
-
2022-01-14
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-01-26
Survey response — 3 months, dose 3MedDRA: Cough, Exposure to SARS-CoV-2, Pain, Pyrexia, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activitiesFree text: Cough, fever, body aches. Two members of my household had positive COVID-19 tests. I tested negative two days before my symptoms began.MedDRA releases: 2024-11 · check-in free text available
- 2022-04-27
-
2022-05-04
Dose 4 — Moderna
- 2022-05-04
-
2022-05-05
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, DiarrheaAdult check-in
- 2022-05-06
- 2022-05-07
- 2022-05-08
- 2022-05-09
-
2022-05-10
Health check-in — days 1–6 daily, dose 4Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
- 2022-05-13
- 2022-05-18
- 2022-05-25
-
2022-06-01
Survey response — day 28, dose 4MedDRA: Cough — Feeling: GoodFree text: Persistent cough.MedDRA releases: 2024-11 · check-in free text available
- 2022-06-08
-
2022-06-15
Survey response — day 42, dose 4MedDRA: Cough — Feeling: GoodFree text: Persistent coughMedDRA releases: 2024-11 · check-in free text available
-
2022-08-03
Survey response — 3 months, dose 4MedDRA: Cough, Pain, Pyrexia — Feeling: FairFree text: Cough, low grade fever, body achesMedDRA releases: 2024-11 · check-in free text available
-
2022-10-14
Dose 5 — Moderna
- 2022-10-14
-
2022-10-15
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Abdominal painAdult check-in
- 2022-10-16
- 2022-10-17
-
2022-10-18
Survey response — days 1–6 daily, dose 5MedDRA: Night sweats — Feeling: Fair · Chills, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to do your normal daily activitiesFree text: Night sweatsMedDRA releases: 2024-11 · check-in free text available
- 2022-10-19
- 2022-10-20
- 2022-10-21
- 2022-10-28
- 2022-11-06
- 2022-11-12
-
2022-11-18
Survey response — day 35, dose 5MedDRA: Arthralgia, Cough, Myalgia — Feeling: GoodFree text: Muscle and joint pain. Cough.MedDRA releases: 2024-11 · check-in free text available
- 2022-11-25
- 2023-01-13
- 2023-04-17
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-25 | Moderna | |
| 2 | 2021-02-23 | Moderna | |
| 3 | 2021-10-27 | Moderna | No |
| 4 | 2022-05-04 | Moderna | No |
| 5 | 2022-10-14 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 4 — day 28, dose 1
Symptoms: Weakness, joint pain, 101.6 fever, diarrhea.
Release 5 — day 21, dose 2
Symptoms: Cough
Release 7 — day 42, dose 2
Symptoms: Lower back pain
Release 8 — 3 months, dose 2
Symptoms: Pain in the left foot for a couple of weeks. Improving now.
Release 9 — 6 months, dose 2
Symptoms: Pain in left foot.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Night sweats
Release 10 — day 21, dose 3
Symptoms: Pink eye
Release 10 — day 28, dose 3
Symptoms: Uveitis with possible herpes zoster in right eye
Healthcare visit (other): Referral to opthalmology department
Release 11 — 3 months, dose 3
Symptoms: Cough, fever, body aches. Two members of my household had positive COVID-19 tests. I tested negative two days before my symptoms began.
Release 11 — day 28, dose 4
Symptoms: Persistent cough.
Release 12 — day 42, dose 4
Symptoms: Persistent cough
Release 12 — 3 months, dose 4
Symptoms: Cough, low grade fever, body aches
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): Night sweats
Release 12 — day 35, dose 5
Symptoms: Muscle and joint pain. Cough.
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 | Unevaluable event | · | · | ✓ |
| SD | Arthralgia | ✓ | ✓ | ✓ |
| SD | Asthenia | ✓ | ✓ | ✓ |
| SD | Back pain | ✓ | ✓ | ✓ |
| SD | Conjunctivitis | · | · | ✓ |
| SD | Cough | ✓ | ✓ | ✓ |
| SD | Diarrhoea | ✓ | ✓ | ✓ |
| SD | Exposure to SARS-CoV-2 | · | · | ✓ |
| SD | Myalgia | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pain in extremity | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SD | Uveitis | · | · | ✓ |
| SRO | Night sweats | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release