6BL-11838-82771
4 vaccinations
5 coded responses
55 check-ins
5 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 986 / WA
- Registered
- 2021-04-21
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-21
Registered in v-safe
-
2021-04-21
Dose 1 — Moderna
- 2021-04-21
-
2021-04-22
Survey response — days 1–6 daily, dose 1MedDRA: Back pain — Feeling: Good · Muscle or body achesFree text: Lower back pain, which isnothing new to me but, very noticible when i rose this morning and cintinued through the day.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-23
Survey response — days 1–6 daily, dose 1MedDRA: Back pain — Feeling: Good · Muscle or body achesFree text: Lower back pain but think not related to vaccinationMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-24
- 2021-04-25
-
2021-04-26
Survey response — days 1–6 daily, dose 1MedDRA: Pain in jaw — Feeling: Good · Joint painsFree text: Right side jaw pain when chewing on that sideMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-27
- 2021-04-28
- 2021-05-05
- 2021-05-12
-
2021-05-19
Dose 2 — Moderna
- 2021-05-20
- 2021-05-21
- 2021-05-22
- 2021-05-23
- 2021-05-24
- 2021-05-25
- 2021-05-26
- 2021-06-02
- 2021-06-09
- 2021-06-16
- 2021-06-23
- 2021-06-30
- 2021-08-18
- 2021-11-17
-
2021-11-21
Dose 3 — Moderna
- 2021-11-21
- 2021-11-22
- 2021-11-23
- 2021-11-24
- 2021-11-25
- 2021-11-26
- 2021-11-27
- 2021-11-28
- 2021-12-05
- 2021-12-12
- 2021-12-19
- 2021-12-26
- 2022-01-02
- 2022-02-20
-
2022-05-22
Survey response — 6 months, dose 3MedDRA: Productive cough, SARS-CoV-2 test negative — Feeling: GoodFree text: March 15th, both (b)(6) and I came down with same symptoms. 3 days of uncontrollable coughing followed by coughing up flim from chest. Home Covid tests were negative. (b)(6) recovered in a few days but I cont to cough up flim. Almost back to normalMedDRA releases: 2024-11 · check-in free text available
-
2022-05-24
Dose 4 — Moderna
- 2022-05-24
- 2022-05-25
- 2022-05-26
-
2022-05-27
Survey response — days 1–6 daily, dose 4MedDRA: Myalgia — Feeling: Good · Muscle or body achesFree text: Pain in right jaw joint muscle near right ear suddenly appeared 2 days ago without any apparent reasonMedDRA releases: 2024-11 · check-in free text available
- 2022-05-28
- 2022-05-29
- 2022-05-30
- 2022-05-31
- 2022-06-08
- 2022-06-14
- 2022-06-21
- 2022-06-28
- 2022-07-05
- 2022-08-24
- 2022-11-22
- 2023-05-24
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-21 | Moderna | |
| 2 | 2021-05-19 | Moderna | |
| 3 | 2021-11-21 | Moderna | No |
| 4 | 2022-05-24 | Moderna | No |
Free text
Release 7 — days 1–6 daily, dose 1
Systemic reaction (other): Lower back pain, which isnothing new to me but, very noticible when i rose this morning and cintinued through the day.
Systemic reaction (other): Lower back pain but think not related to vaccination
Release 8 — days 1–6 daily, dose 1
Systemic reaction (other): Right side jaw pain when chewing on that side
Release 11 — 6 months, dose 3
Symptoms: March 15th, both (b)(6) and I came down with same symptoms. 3 days of uncontrollable coughing followed by coughing up flim from chest. Home Covid tests were negative. (b)(6) recovered in a few days but I cont to cough up flim. Almost back to normal cut off by CDC
redacted (b)(6)
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Pain in right jaw joint muscle near right ear suddenly appeared 2 days ago without any apparent reason
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 |
|---|---|---|---|---|
| SD | Productive cough | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Back pain | ✓ | ✓ | ✓ |
| SRO | Myalgia | · | · | ✓ |
| SRO | Pain in jaw | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release