775-93143-13688
2 vaccinations
3 coded responses
24 check-ins
3 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 0-4
- ZIP prefix
- 620 / IL
- Registered
- 2022-07-19
- Relationship
- Child or adolescent in my care
- Guardian
- Q6K-17670-39634
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2022-07-18
Dose 1 — Moderna
-
2022-07-19
Registered in v-safe
- 2022-07-19
- 2022-07-20
- 2022-07-21
- 2022-07-22
- 2022-07-23
- 2022-07-24
- 2022-07-25
- 2022-08-01
- 2022-08-08
-
2022-08-15
Dose 2 — Moderna
- 2022-08-15
-
2022-08-16
Survey response — days 1–6 daily, dose 2, dependentMedDRA: Palpitations — Feeling: Good · FeverFree text: Heart was racingMedDRA releases: 2024-11 · check-in free text available
- 2022-08-17
- 2022-08-18
- 2022-08-19
- 2022-08-20
- 2022-08-21
- 2022-08-22
- 2022-08-29
- 2022-09-05
-
2022-09-12
Survey response — day 28, dose 2, dependentMedDRA: Rash, Rash pruritic — Feeling: FairFree text: He has an itchy rash all over his body. I have no idea if it's vaccine related or not. It started two days ago.MedDRA releases: 2024-11 · check-in free text available
-
2022-09-19
Survey response — day 35, dose 2, dependentMedDRA: Cough, Infection, Rash, Rhinorrhoea, Varicella — Feeling: Fair · Be unable to work or attend schoolFree text: Full body rash (pediatrician suspects breakthrough case of chickenpox), runny nose, and cough.MedDRA releases: 2024-11 · check-in free text available
- 2022-09-26
- 2022-11-14
- 2023-02-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2022-07-18 | Moderna | No |
| 2 | 2022-08-15 | Moderna | No |
Free text
Release 12 — days 1–6 daily, dose 2, dependent
Systemic reaction (other): Heart was racing
Release 12 — day 28, dose 2, dependent
Symptoms: He has an itchy rash all over his body. I have no idea if it's vaccine related or not. It started two days ago.
Release 12 — day 35, dose 2, dependent
Symptoms: Full body rash (pediatrician suspects breakthrough case of chickenpox), runny nose, and cough.
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 | Cough | · | · | ✓ |
| SD | Infection | · | · | ✓ |
| SD | Rash | · | · | ✓ |
| SD | Rash pruritic | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Varicella | · | · | ✓ |
| SRO | Palpitations | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release