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6L4-28845-04194

2 vaccinations 3 coded responses 23 check-ins 3 free-text entries 0 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
531 / WI
Registered
2021-02-21
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-20
    Dose 1 — Moderna
  2. 2021-02-21
    Registered in v-safe
  3. 2021-02-21
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  4. 2021-02-22
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Headache
    Adult check-in
  5. 2021-02-23
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-02-24
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-02-25
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-02-26
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-02-27
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  10. 2021-03-07
    Survey response — day 14, dose 1
    MedDRA: Injection site erythema, Injection site pruritus — Feeling: Good
    Free text: 10 days after injection I had a Slight redness in a 2 area around the injection site. That spot was slightly itchy for a few days and then it cleared up. Nothing major with it. Just telling you what I observed.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-03-13
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-03-22
    Dose 2 — Moderna
  13. 2021-03-23
    Health check-in — days 1–6 daily, dose 2
    Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities
    Adult check-in
  14. 2021-03-24
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Redness, Swelling · None
    Adult check-in
  15. 2021-03-25
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Redness, Swelling, Itching · None
    Adult check-in
  16. 2021-03-26
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  17. 2021-03-27
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  18. 2021-03-28
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  19. 2021-03-29
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  20. 2021-04-06
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-04-12
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-04-19
    Survey response — day 28, dose 2
    MedDRA: Dyspnoea, Fatigue, Gait disturbance, Palpitations — Feeling: Good
    Free text: Since 1st shot:Shortness of breath, fatigued, cannot walk 2 miles without stopping five or six times to catch my breath. Had echo, carotid, EKG in January. No issues with those tests. Seems like my heart pounds a lot. I have no other health issues .
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  23. 2021-04-28
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-05-04
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-09-20
    Survey response — 6 months, dose 2
    MedDRA: Dyspnoea, Electrocardiogram abnormal, Exercise tolerance decreased, Loss of consciousness, Medical counselling, Ventricular extrasystoles — Feeling: Good
    Free text: Clear carotid and echocardiogram in January 2021. Moderno vaccine in February and March. Afterward having shortness of breath and had to stop while walking. In June passed out on the golf course. EKG shows isolated PVC. Have had consult with cardiort
    MedDRA releases: 2024-11 · check-in free text available
  26. 2022-03-27
    Health check-in — 12 months, dose 2
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-02-20Moderna
22021-03-22Moderna

Free text

Release 5 — day 14, dose 1

2021-03-07

Symptoms: 10 days after injection I had a Slight redness in a 2 area around the injection site. That spot was slightly itchy for a few days and then it cleared up. Nothing major with it. Just telling you what I observed.

Release 7 — day 28, dose 2

2021-04-19

Symptoms: Since 1st shot:Shortness of breath, fatigued, cannot walk 2 miles without stopping five or six times to catch my breath. Had echo, carotid, EKG in January. No issues with those tests. Seems like my heart pounds a lot. I have no other health issues . cut off by CDC

Release 9 — 6 months, dose 2

2021-09-20

Symptoms: Clear carotid and echocardiogram in January 2021. Moderno vaccine in February and March. Afterward having shortness of breath and had to stop while walking. In June passed out on the golf course. EKG shows isolated PVC. Have had consult with cardiort cut off by CDC

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

FieldPreferred term2021-092023-042024-11
SDDyspnoea ✓ ✓ ✓
SDElectrocardiogram abnormal · · ✓
SDExercise tolerance decreased · · ✓
SDFatigue ✓ ✓ ✓
SDGait disturbance ✓ ✓ ✓
SDInjection site erythema ✓ ✓ ✓
SDInjection site pruritus ✓ ✓ ✓
SDLoss of consciousness · · ✓
SDMedical counselling · · ✓
SDPalpitations ✓ ✓ ✓
SDVentricular extrasystoles · · ✓

✓ active code · ○ coded but marked inactive · blank = not in that release