6PJ-50013-90955
3 vaccinations
6 coded responses
33 check-ins
6 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 920 / CA
- Registered
- 2021-01-24
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-24
Registered in v-safe
-
2021-01-24
Dose 1 — Moderna
- 2021-01-24
-
2021-01-25
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-01-26
- 2021-01-27
- 2021-01-28
- 2021-01-29
-
2021-01-30
Survey response — days 1–6 daily, dose 1MedDRA: Pain, Pre-existing disease — Feeling: Good · Muscle or body aches, Fatigue or tirednessFree text: i have degenerate joint problems (arthritis) .. Its not unusual for me to have periodic aches and painMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-31
- 2021-02-07
- 2021-02-14
-
2021-02-19
Dose 2 — Moderna
-
2021-02-21
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2021-02-22
- 2021-02-23
- 2021-02-24
- 2021-02-25
- 2021-02-26
- 2021-03-05
-
2021-03-12
Survey response — day 21, dose 2MedDRA: Injection site pain — Feeling: GoodFree text: mild pain at injection site started about a week ago... perhaps coincidenceMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-19
- 2021-03-26
- 2021-04-02
- 2021-05-21
-
2021-08-15
Dose 3 — Moderna
- 2021-08-20
-
2021-08-20
Survey response — days 1–6 daily, dose 3MedDRA: Arthralgia, Joint swelling — Feeling: GoodFree text: mild shoulder pain and swelling for 2-3 daysMedDRA releases: 2021-09,2024-11 · check-in free text available
- 2021-08-21
- 2021-08-22
-
2021-08-29
Survey response — day 14, dose 3MedDRA: Headache, Neck pain, Office visit, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activitiesFree text: neck pain and headache for 2 days probably due to cervical arthritis and chiropractic manipulation. Doubtful it has anything to do with covid and the problem is gone now.im just trying to be thorough in my answers. :)MedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-09-05
Survey response — day 21, dose 3MedDRA: Dehydration, Headache, Heart rate increased, Hospitalisation, Hypertension, Nausea, SARS-CoV-2 test negative, White blood cell count increased — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: dehydrated, headache, nausea and fast pulse and high bp.. im in (b)(6) hospital observation .. im covid negative :))some kind of infection maybe as white blood cells elevatedMedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-09-05
Report sent to call center — day 21, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-09-10
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-09-12
- 2021-09-19
- 2021-09-26
- 2021-11-14
-
2022-02-13
Survey response — 6 months, dose 3MedDRA: Chills, Headache, Myalgia, Rhinorrhoea — Feeling: Good · Be unable to do your normal daily activitiesFree text: chills, headache, runny nose, muscle achesMedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-24 | Moderna | |
| 2 | 2021-02-19 | Moderna | |
| 3 | 2021-08-15 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): i have degenerate joint problems (arthritis) .. Its not unusual for me to have periodic aches and pain
Release 5 — day 21, dose 2
Symptoms: mild pain at injection site started about a week ago... perhaps coincidence
Release 9 — days 1–6 daily, dose 3
Systemic reaction (other): mild shoulder pain and swelling for 2-3 days
Release 9 — day 14, dose 3
Symptoms: neck pain and headache for 2 days probably due to cervical arthritis and chiropractic manipulation. Doubtful it has anything to do with covid and the problem is gone now.im just trying to be thorough in my answers. :)
Release 9 — day 21, dose 3
Symptoms: dehydrated, headache, nausea and fast pulse and high bp.. im in (b)(6) hospital observation .. im covid negative :))some kind of infection maybe as white blood cells elevated
redacted (b)(6)
Release 11 — 6 months, dose 3
Symptoms: chills, headache, runny nose, muscle aches
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 | Chills | · | · | ✓ |
| SD | Dehydration | ✓ | · | ✓ |
| SD | Headache | ✓ | · | ✓ |
| SD | Heart rate increased | ✓ | · | ✓ |
| SD | Hospitalisation | ✓ | · | ✓ |
| SD | Hypertension | ✓ | · | ✓ |
| SD | Injection site pain | ✓ | ✓ | ✓ |
| SD | Myalgia | · | · | ✓ |
| SD | Nausea | ✓ | · | ✓ |
| SD | Neck pain | ✓ | · | ✓ |
| SD | Office visit | ✓ | · | ✓ |
| SD | Pre-existing disease | ✓ | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | SARS-CoV-2 test negative | ✓ | · | ✓ |
| SD | White blood cell count increased | ✓ | · | ✓ |
| SRO | Arthralgia | ✓ | · | ✓ |
| SRO | Joint swelling | ✓ | · | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release