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F6N-32034-86105

5 vaccinations 1 coded response 27 check-ins 1 free-text entry 2 call cases
Sex
Male
Age at first dose
56-60
ZIP prefix
658 / MO
Registered
2021-12-10
Relationship
Adult relative or friend
Guardian
2FS-33847-29792
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-25
    Dose 1 — Moderna
  2. 2021-03-01
    Dose 2 — Moderna
  3. 2021-12-10
    Registered in v-safe
  4. 2021-12-17
    Dose 3 — Moderna
  5. 2021-12-17
    Health check-in — day 0, dose 3, dependent
    Feeling: Fair · None
    Adult check-in
  6. 2021-12-19
    Health check-in — days 1–6 daily, dose 3, dependent
    Feeling: Fair · Site: Pain · None
    Adult check-in
  7. 2021-12-20
    Health check-in — days 1–6 daily, dose 3, dependent
    Feeling: Fair · Site: Pain · Chills
    Adult check-in
  8. 2021-12-21
    Health check-in — days 1–6 daily, dose 3, dependent
    Feeling: Fair · Site: Pain · None
    Adult check-in
  9. 2021-12-26
    Health check-in — day 7, dose 3, dependent
    Feeling: Poor · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities
    Adult check-in
  10. 2022-01-02
    Health check-in — day 14, dose 3, dependent
    Feeling: Fair
    Adult check-in
  11. 2022-01-23
    Health check-in — day 35, dose 3, dependent
    Feeling: Good
    Adult check-in
  12. 2022-03-18
  13. 2022-06-19
  14. 2022-07-17
    Dose 4 — Moderna
  15. 2022-07-17
    Health check-in — day 0, dose 4, dependent
    Feeling: Good · Site: Pain · None
    Adult check-in
  16. 2022-07-18
    Health check-in — days 1–6 daily, dose 4, dependent
    Feeling: Good · Site: Pain · None
    Adult check-in
  17. 2022-07-19
    Health check-in — days 1–6 daily, dose 4, dependent
    Feeling: Good · None
    Adult check-in
  18. 2022-07-21
    Health check-in — days 1–6 daily, dose 4, dependent
    Feeling: Fair · None
    Adult check-in
  19. 2022-07-23
    Health check-in — days 1–6 daily, dose 4, dependent
    Feeling: Poor · Fever · None · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit
    Adult check-in
  20. 2022-07-23
    Report sent to call center — days 1–6 daily, dose 4, dependent
    Get care from a doctor or other healthcare professional
    Emergency room or emergency department visit · 1 call case(s)
  21. 2022-07-24
    Survey response — day 7, dose 4, dependent
    MedDRA: Condition aggravated, Hospitalisation, Hypercapnia, Metabolic encephalopathy, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Hospitalization
    Free text: In hospital with COPD exacerbation with metabolic encephalopathy due to hypercapnia
    MedDRA releases: 2024-11 · check-in free text available
  22. 2022-07-24
    Report sent to call center — day 7, dose 4, dependent
    Get care from a doctor or other healthcare professional
    Hospitalization · 1 call case(s)
  23. 2022-07-25
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  24. 2022-07-25
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  25. 2022-08-07
    Health check-in — day 21, dose 4, dependent
    Feeling: Good
    Adult check-in
  26. 2022-08-16
    Health check-in — day 28, dose 4, dependent
    Feeling: Good
    Adult check-in
  27. 2022-08-23
    Health check-in — day 35, dose 4, dependent
    Feeling: Good
    Adult check-in
  28. 2022-10-16
  29. 2022-11-21
    Dose 5 — Moderna
    Co-administered: Flu
  30. 2022-11-22
    Health check-in — days 1–6 daily, dose 5, dependent
    Feeling: Fair · Site: Pain · None
    Adult check-in
  31. 2022-11-24
    Health check-in — days 1–6 daily, dose 5, dependent
    Feeling: Good · None
    Adult check-in
  32. 2022-11-26
    Health check-in — days 1–6 daily, dose 5, dependent
    Feeling: Good · None
    Adult check-in
  33. 2022-11-27
    Health check-in — days 1–6 daily, dose 5, dependent
    Feeling: Good · None
    Adult check-in
  34. 2022-12-08
    Health check-in — day 14, dose 5, dependent
    Feeling: Good
    Adult check-in
  35. 2022-12-12
    Health check-in — day 21, dose 5, dependent
    Feeling: Good
    Adult check-in
  36. 2022-12-19
    Health check-in — day 28, dose 5, dependent
    Feeling: Good
    Adult check-in
  37. 2023-01-02
    Health check-in — day 42, dose 5, dependent
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-01-25Moderna No
22021-03-01Moderna No
32021-12-17Moderna No
42022-07-17Moderna No
52022-11-21Moderna Flu

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 12 — day 7, dose 4, dependent

2022-07-24

Systemic reaction (other): In hospital with COPD exacerbation with metabolic encephalopathy due to hypercapnia

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
SROCondition aggravated · · ✓
SROHospitalisation · · ✓
SROHypercapnia · · ✓
SROMetabolic encephalopathy · · ✓
SROPre-existing disease · · ✓

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

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