6G8-26794-03034
4 vaccinations
3 coded responses
36 check-ins
3 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 208 / MD
- Registered
- 2021-01-12
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-11
Dose 1 — Moderna
-
2021-01-12
Registered in v-safe
- 2021-01-12
- 2021-01-16
- 2021-01-17
-
2021-01-18
Survey response — day 7, dose 1MedDRA: Arthralgia — Feeling: Good · Joint painsFree text: Little pain in right elbow last 3 days. Shot was in left arm.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-28
Survey response — day 14, dose 1MedDRA: Cough, Dyspnoea, Lung disorder, Office visit, Productive cough, SARS-CoV-2 test negative — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, HospitalizationFree text: Shortness of breath over last week. 2 days bad. Cough plem down low. Currently in Kaiser urgent care treating for clots in both lungs. Covids tests both negative.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-28
Report sent to call center — day 14, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-02-02
Survey response — day 21, dose 1MedDRA: Dyspnoea, Office visit, Pulmonary embolism, SARS-CoV-2 test negative — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Blood clots in both lungs. Night in urgent care to find cause of short breath. Cause of clots unknown - but not from legs. Blood thinner injections twice day very helpfulTesting will continue. Two Covid tests negative.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-02
Report sent to call center — day 21, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-02-08
-
2021-02-09
Dose 2 — Moderna
- 2021-02-09
- 2021-02-10
- 2021-02-12
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-16
- 2021-02-23
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-05-11
-
2021-06-07
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-08-10
-
2021-11-22
Dose 3 — Moderna
- 2022-02-09
-
2022-04-26
Dose 4 — Moderna
- 2022-04-28
- 2022-04-29
- 2022-04-30
- 2022-05-01
- 2022-05-02
- 2022-05-03
- 2022-05-11
- 2022-05-17
- 2022-05-24
- 2022-06-02
- 2022-06-09
- 2022-07-27
- 2022-10-25
- 2023-04-26
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-11 | Moderna | |
| 2 | 2021-02-09 | Moderna | |
| 3 | 2021-11-22 | Moderna | No |
| 4 | 2022-04-26 | Moderna | No |
Call center
2 call center cases
2 successful
Free text
Release 2 — day 7, dose 1
Systemic reaction (other): Little pain in right elbow last 3 days. Shot was in left arm.
Release 2 — day 14, dose 1
Symptoms: Shortness of breath over last week. 2 days bad. Cough plem down low. Currently in Kaiser urgent care treating for clots in both lungs. Covids tests both negative.
Release 3 — day 21, dose 1
Symptoms: Blood clots in both lungs. Night in urgent care to find cause of short breath. Cause of clots unknown - but not from legs. Blood thinner injections twice day very helpfulTesting will continue. Two Covid tests 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 |
|---|---|---|---|---|
| SD | Cough | ✓ | ✓ | ✓ |
| SD | Dyspnoea | ✓ | ✓ | ✓ |
| SD | Lung disorder | ✓ | ✓ | ✓ |
| SD | Office visit | ✓ | ✓ | ✓ |
| SD | Productive cough | ✓ | ✓ | ✓ |
| SD | Pulmonary embolism | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | ✓ | ✓ | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release