6UT-17411-51571
2 vaccinations
4 coded responses
6 check-ins
4 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 51-55
- ZIP prefix
- 622 / IL
- Registered
- 2021-04-21
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-18
Dose 1 — Moderna
-
2021-04-15
Dose 2 — Moderna
-
2021-04-21
Registered in v-safe
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2021-04-21
Survey response — days 1–6 daily, dose 2MedDRA: Dyspnoea — Feeling: Good · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activitiesFree text: Out of breath easyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-23
- 2021-04-29
-
2021-05-13
Survey response — day 28, dose 2MedDRA: Decreased appetite, Fatigue, Malaise, Nausea — Feeling: PoorFree text: I feel sick and nausea and very tired. I felt this way for about four days now. Missing with my appetite also. Not hungryMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-25
Survey response — day 35, dose 2MedDRA: No adverse event — Feeling: GoodFree text: None any more so forMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-10-14
Survey response — 6 months, dose 2MedDRA: Cardiac dysfunction, Chest pain, Dyspnoea, Unevaluable event — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: I have a mis fictioning heart that doctor put a heart monitor on for thirty days to see why I get chest pains and difficulty breathing... I have never smoked ... I am dietetic . But not saying it is related to the vaccine.... But thought I mintion it · Healthcare visit (other): Heart monitor.. and cardiac cath. Was done.MedDRA releases: 2024-11 · check-in free text available
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2021-10-14
Report sent to call center — 6 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
- 2021-11-17
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-18 | Moderna | |
| 2 | 2021-04-15 | Moderna |
Call center
1 call center case
1 unsuccessful
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Out of breath easy
Release 8 — day 28, dose 2
Symptoms: I feel sick and nausea and very tired. I felt this way for about four days now. Missing with my appetite also. Not hungry
Release 8 — day 35, dose 2
Symptoms: None any more so for
Release 10 — 6 months, dose 2
Symptoms: I have a mis fictioning heart that doctor put a heart monitor on for thirty days to see why I get chest pains and difficulty breathing... I have never smoked ... I am dietetic . But not saying it is related to the vaccine.... But thought I mintion it cut off by CDC
Healthcare visit (other): Heart monitor.. and cardiac cath. Was done.
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 |
|---|---|---|---|---|
| HCVO | Unevaluable event | · | · | ✓ |
| SD | Cardiac dysfunction | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Decreased appetite | ✓ | ✓ | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Malaise | ✓ | ✓ | ✓ |
| SD | Nausea | ✓ | ✓ | ✓ |
| SD | No adverse event | ✓ | ✓ | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SRO | Dyspnoea | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release