6XJ-11172-76920
4 vaccinations
6 coded responses
31 check-ins
6 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 341 / FL
- Registered
- 2021-02-26
- Relationship
- Self
- Race
- Multiracial
- Ethnicity
- Not Hispanic or Latino
Registered dependents
PAE-13946-98354
Other · Male · 2022-04-30
Timeline
-
2021-02-26
Registered in v-safe
-
2021-02-26
Dose 1 — Moderna
-
2021-02-26
Survey response — day 0, dose 1MedDRA: Injection site pain — Feeling: GoodFree text: Slight soreness around the shot areaMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-27
-
2021-02-28
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: Good · Site: Swelling · Fatigue or tirednessFree text: My arm is really sore in the shot area. It got worse overnight, but no redness to speak of.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-02
Survey response — days 1–6 daily, dose 1MedDRA: Hypersomnia, Somnolence — Feeling: Good · Fatigue or tirednessFree text: I seem to be sleeping more than usual, but nothing debilitating other than that.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-04
- 2021-03-05
- 2021-03-12
- 2021-03-19
-
2021-03-26
Dose 2 — Moderna
- 2021-03-26
-
2021-03-28
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-30
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue — Feeling: Good · Headache · Be unable to do your normal daily activitiesFree text: Yesterday I couldnt report in because I was still very fatigued. Didnt accomplish what I normally do in a day, but never felt sick!MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-31
- 2021-04-01
- 2021-04-02
- 2021-04-09
- 2021-04-16
- 2021-04-23
- 2021-04-30
- 2021-05-07
-
2021-06-25
Survey response — 3 months, dose 2MedDRA: Infection, Malaise, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Had to hv an unrelated minor operation after a long-overdue wellness exam. The op was successful, but I got an infection and am a little under the weather, but expect to be ok by next week. · Healthcare visit (other): Planned operation with a Urologist & anesthesiologist. Left the hospital the same day to convalesce.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-06-25
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2021-07-01
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2021-09-24
-
2021-11-12
Dose 3 — Moderna
- 2022-03-27
-
2022-04-24
Dose 4 — Moderna
- 2022-05-04
- 2022-05-08
- 2022-05-15
- 2022-05-22
- 2022-05-29
- 2022-06-05
-
2022-07-24
Survey response — 3 months, dose 4MedDRA: Corneal transplant, Office visit — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Corneal transplant performed on left eye 7/20/22. · Healthcare visit (other): (b)(6) Eye InstituteMedDRA releases: 2024-11 · check-in free text available
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2022-07-24
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
-
2022-07-25
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-10-23
- 2023-04-25
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-26 | Moderna | |
| 2 | 2021-03-26 | Moderna | |
| 3 | 2021-11-12 | Moderna | No |
| 4 | 2022-04-24 | Moderna | No |
Call center
2 call center cases
2 successful
Free text
Release 4 — day 0, dose 1
Systemic reaction (other): Slight soreness around the shot area
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): My arm is really sore in the shot area. It got worse overnight, but no redness to speak of.
Systemic reaction (other): I seem to be sleeping more than usual, but nothing debilitating other than that.
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Yesterday I couldnt report in because I was still very fatigued. Didnt accomplish what I normally do in a day, but never felt sick!
Release 9 — 3 months, dose 2
Symptoms: Had to hv an unrelated minor operation after a long-overdue wellness exam. The op was successful, but I got an infection and am a little under the weather, but expect to be ok by next week.
Healthcare visit (other): Planned operation with a Urologist & anesthesiologist. Left the hospital the same day to convalesce.
Release 12 — 3 months, dose 4
Symptoms: Corneal transplant performed on left eye 7/20/22.
Healthcare visit (other): (b)(6) Eye Institute
redacted (b)(6)
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 | Office visit | · | · | ✓ |
| HCVO | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Corneal transplant | · | · | ✓ |
| SD | Infection | ✓ | ✓ | ✓ |
| SD | Malaise | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Hypersomnia | ○ | ✓ | ○ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Somnolence | ✓ | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release