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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

  1. 2021-03-18
    Dose 1 — Moderna
  2. 2021-04-15
    Dose 2 — Moderna
  3. 2021-04-21
    Registered in v-safe
  4. 2021-04-21
    Survey response — days 1–6 daily, dose 2
    MedDRA: 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 activities
    Free text: Out of breath easy
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-04-23
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  6. 2021-04-29
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  7. 2021-05-13
    Survey response — day 28, dose 2
    MedDRA: Decreased appetite, Fatigue, Malaise, Nausea — Feeling: Poor
    Free text: I feel sick and nausea and very tired. I felt this way for about four days now. Missing with my appetite also. Not hungry
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-05-25
    Survey response — day 35, dose 2
    MedDRA: No adverse event — Feeling: Good
    Free text: None any more so for
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-10-14
    Survey response — 6 months, dose 2
    MedDRA: 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 professional
    Free 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
  10. 2021-10-14
    Report sent to call center — 6 months, dose 2
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    1 call case(s)
  11. 2021-11-17

Vaccinations

DoseDateManufacturerCo-administered
12021-03-18Moderna
22021-04-15Moderna

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-21

Systemic reaction (other): Out of breath easy

Release 8 — day 28, dose 2

2021-05-13

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

2021-05-25

Symptoms: None any more so for

Release 10 — 6 months, dose 2

2021-10-14

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

FieldPreferred term2021-092023-042024-11
HCVOUnevaluable event · · ✓
SDCardiac dysfunction · · ✓
SDChest pain · · ✓
SDDecreased appetite ✓ ✓ ✓
SDDyspnoea · · ✓
SDFatigue ✓ ✓ ✓
SDMalaise ✓ ✓ ✓
SDNausea ✓ ✓ ✓
SDNo adverse event ✓ ✓ ✓
SDUnevaluable event · · ✓
SRODyspnoea ✓ ✓ ✓

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