KU5-13964-64544
4 vaccinations
1 coded response
8 check-ins
0 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 770 / TX
- Registered
- 2022-04-19
- Relationship
- Adult relative or friend
- Guardian
- 2CP-32551-04221
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-12
Dose 1 — Moderna
-
2021-02-09
Dose 2 — Moderna
-
2021-10-25
Dose 3 — Moderna
-
2022-04-02
Dose 4 — Moderna
-
2022-04-19
Registered in v-safe
- 2022-04-19
- 2022-04-25
- 2022-04-30
- 2022-05-07
- 2022-05-14
- 2022-07-03
- 2022-10-01
-
2023-04-09
Survey response — 12 months, dose 4, dependentMedDRA: Death — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationMedDRA releases: 2024-11
-
2023-04-09
Report sent to call center — 12 months, dose 4, dependentBe unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prEmergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2023-04-12
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-12 | Moderna | No |
| 2 | 2021-02-09 | Moderna | No |
| 3 | 2021-10-25 | Moderna | No |
| 4 | 2022-04-02 | Moderna | No |
Call center
1 call center case
1 unsuccessful
Free text
None.
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 | Death | · | · | ✓ |
| SD | Death | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release