TKT-11364-16615
2 vaccinations
1 coded response
23 check-ins
1 free-text entry
1 call case
- Sex
- Male
- Age at first dose
- 0-4
- ZIP prefix
- 027 / MA
- Registered
- 2022-06-29
- Relationship
- Child or adolescent in my care
- Guardian
- CB3-12075-01371
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2022-06-29
Registered in v-safe
-
2022-07-02
Dose 1 — Moderna
- 2022-07-02
- 2022-07-03
- 2022-07-04
- 2022-07-05
- 2022-07-06
- 2022-07-07
- 2022-07-11
- 2022-07-16
- 2022-07-23
-
2022-07-30
Dose 2 — Moderna
- 2022-07-30
- 2022-07-31
-
2022-08-01
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Good · Site: Redness · NoneAdult check-in
- 2022-08-03
- 2022-08-04
- 2022-08-05
- 2022-08-06
- 2022-08-13
- 2022-08-20
- 2022-08-27
- 2022-09-03
-
2022-09-10
Survey response — day 42, dose 2, dependentMedDRA: Dyspnoea — Feeling: Fair · 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 visitFree text: Shortness of breathMedDRA releases: 2024-11 · check-in free text available
-
2022-09-10
Report sent to call center — day 42, dose 2, 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 · 1 call case(s)
-
2022-09-12
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-10-31
- 2023-01-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2022-07-02 | Moderna | No |
| 2 | 2022-07-30 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 12 — day 42, dose 2, dependent
Symptoms: Shortness of breath
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 | Dyspnoea | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release