67G-29665-92186
5 vaccinations
5 coded responses
43 check-ins
5 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 957 / CA
- Registered
- 2021-01-21
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-21
Registered in v-safe
-
2021-01-21
Dose 1 — Moderna
- 2021-01-21
- 2021-01-22
- 2021-01-24
- 2021-01-25
- 2021-01-26
- 2021-01-27
-
2021-01-28
Survey response — day 7, dose 1MedDRA: Dry skin, Rash, Rash erythematous — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: Spots appeared on my leg, 1 inch circle, not itchy, just red & rough skin. I have had the Shingles shots.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-04
- 2021-02-11
- 2021-02-18
-
2021-02-19
Dose 2 — Moderna
- 2021-02-24
- 2021-02-25
- 2021-02-26
-
2021-03-05
Survey response — day 14, dose 2MedDRA: Rash — Feeling: GoodFree text: Rash on left arm.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-12
-
2021-03-19
Survey response — day 28, dose 2MedDRA: Eczema — Feeling: GoodFree text: Exezma on my right arm, like I had on my left arm after the 2nd Moderna shot. Not itchy & left leg, left arm, & now right arm.Never had this ever before.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-26
- 2021-04-02
-
2021-05-21
Survey response — 3 months, dose 2MedDRA: Dry skin, Office visit, Rash — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Continuing skin rashes in streaks on my arms & legs, and small spots, some reddish, some just dry skin spots. NotItchy. Dermatologist said to put cream on them. Routine check up, did not go because of the rashes. · Healthcare visit (other): Already had 6 month routine ck up with dermatologist.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-21
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-20
-
2021-10-29
Dose 3 — Moderna
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-05
- 2021-11-12
-
2021-11-19
Survey response — day 21, dose 3MedDRA: Arthralgia, Chest pain — Feeling: FairFree text: Pain between upper shoulders & sore chest, no problem breathing. Head clear & no coughing.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-26
- 2021-12-03
- 2021-12-10
- 2022-01-28
-
2022-03-04
Dose 4 — Moderna
- 2022-04-16
-
2022-05-06
Call successfulNot applicable - Accidental Reporting
- 2022-06-03
- 2022-09-02
-
2022-09-08
Dose 5 — Moderna
- 2022-10-03
- 2022-10-06
- 2022-10-13
- 2022-10-20
- 2022-12-08
- 2023-03-09
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-21 | Moderna | |
| 2 | 2021-02-19 | Moderna | |
| 3 | 2021-10-29 | Moderna | No |
| 4 | 2022-03-04 | Moderna | No |
| 5 | 2022-09-08 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 3 — day 7, dose 1
Systemic reaction (other): Spots appeared on my leg, 1 inch circle, not itchy, just red & rough skin. I have had the Shingles shots.
Release 5 — day 14, dose 2
Symptoms: Rash on left arm.
Release 5 — day 28, dose 2
Symptoms: Exezma on my right arm, like I had on my left arm after the 2nd Moderna shot. Not itchy & left leg, left arm, & now right arm.Never had this ever before.
Release 8 — 3 months, dose 2
Symptoms: Continuing skin rashes in streaks on my arms & legs, and small spots, some reddish, some just dry skin spots. NotItchy. Dermatologist said to put cream on them. Routine check up, did not go because of the rashes.
Healthcare visit (other): Already had 6 month routine ck up with dermatologist.
Release 10 — day 21, dose 3
Symptoms: Pain between upper shoulders & sore chest, no problem breathing. Head clear & no coughing.
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 | Office visit | ✓ | ✓ | ✓ |
| SD | Arthralgia | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Dry skin | ✓ | ✓ | ✓ |
| SD | Eczema | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SRO | Dry skin | ✓ | ✓ | ✓ |
| SRO | Rash | ✓ | ✓ | ✓ |
| SRO | Rash erythematous | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release