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
-
2021-02-20
Dose 1 — Moderna
-
2021-02-21
Registered in v-safe
- 2021-02-21
- 2021-02-22
- 2021-02-23
- 2021-02-24
- 2021-02-25
- 2021-02-26
- 2021-02-27
-
2021-03-07
Survey response — day 14, dose 1MedDRA: Injection site erythema, Injection site pruritus — Feeling: GoodFree 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
- 2021-03-13
-
2021-03-22
Dose 2 — Moderna
-
2021-03-23
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-24
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Swelling · NoneAdult check-in
-
2021-03-25
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Swelling, Itching · NoneAdult check-in
- 2021-03-26
- 2021-03-27
- 2021-03-28
- 2021-03-29
- 2021-04-06
- 2021-04-12
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2021-04-19
Survey response — day 28, dose 2MedDRA: Dyspnoea, Fatigue, Gait disturbance, Palpitations — Feeling: GoodFree 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
- 2021-04-28
- 2021-05-04
-
2021-09-20
Survey response — 6 months, dose 2MedDRA: Dyspnoea, Electrocardiogram abnormal, Exercise tolerance decreased, Loss of consciousness, Medical counselling, Ventricular extrasystoles — Feeling: GoodFree 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 cardiortMedDRA releases: 2024-11 · check-in free text available
- 2022-03-27
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-20 | Moderna | |
| 2 | 2021-03-22 | Moderna |
Free text
Release 5 — day 14, dose 1
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
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
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
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| SD | Dyspnoea | ✓ | ✓ | ✓ |
| SD | Electrocardiogram abnormal | · | · | ✓ |
| SD | Exercise tolerance decreased | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Gait disturbance | ✓ | ✓ | ✓ |
| SD | Injection site erythema | ✓ | ✓ | ✓ |
| SD | Injection site pruritus | ✓ | ✓ | ✓ |
| SD | Loss of consciousness | · | · | ✓ |
| SD | Medical counselling | · | · | ✓ |
| SD | Palpitations | ✓ | ✓ | ✓ |
| SD | Ventricular extrasystoles | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release