W37-16059-38373
3 vaccinations
4 coded responses
15 check-ins
4 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 26-30
- ZIP prefix
- 604 / IL
- Registered
- 2021-11-02
- Relationship
- Adult relative or friend
- Guardian
- ZHZ-27602-46505
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-18
Dose 1 — Moderna
-
2021-04-15
Dose 2 — Moderna
-
2021-11-02
Registered in v-safe
-
2021-11-02
Dose 3 — Moderna
-
2021-11-02
Survey response — day 0, dose 3, dependentMedDRA: Pre-existing disease, Somnolence — Feeling: Good · Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activitiesFree text: He is nonverbal. He went to bed 5 hours after receiving the 3rd shot. He slept for 4 hours now he is back to himselfMedDRA releases: 2024-11 · check-in free text available
-
2021-11-03
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Fair · Fever · Joint pains, Muscle or body aches, DiarrheaAdult check-in
-
2021-11-05
Survey response — days 1–6 daily, dose 3, dependentMedDRA: Rash — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: A rash appears to be on the opposite arm located on his forearmMedDRA releases: 2024-11 · check-in free text available
- 2021-11-06
- 2021-11-07
- 2021-11-08
- 2021-11-09
- 2021-11-16
- 2021-11-23
- 2021-11-30
- 2021-12-07
- 2021-12-14
-
2022-02-01
Survey response — 3 months, dose 3, dependentMedDRA: Increased upper airway secretion, Throat clearing — Feeling: GoodFree text: He wakes up with clear really thick phlem in his throat for the past couple of weeks. He is able to clear it and once it is clear he goes back to his daily routine.MedDRA releases: 2024-11 · check-in free text available
-
2022-05-03
Survey response — 6 months, dose 3, dependentMedDRA: Nasal congestion — Feeling: FairFree text: Mucous in nasal passage in the morningsMedDRA releases: 2024-11 · check-in free text available
- 2022-11-02
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-18 | Moderna | No |
| 2 | 2021-04-15 | Moderna | No |
| 3 | 2021-11-02 | Moderna | No |
Free text
Release 10 — day 0, dose 3, dependent
Systemic reaction (other): He is nonverbal. He went to bed 5 hours after receiving the 3rd shot. He slept for 4 hours now he is back to himself
Release 10 — days 1–6 daily, dose 3, dependent
Systemic reaction (other): A rash appears to be on the opposite arm located on his forearm
Release 11 — 3 months, dose 3, dependent
Symptoms: He wakes up with clear really thick phlem in his throat for the past couple of weeks. He is able to clear it and once it is clear he goes back to his daily routine.
Release 11 — 6 months, dose 3, dependent
Symptoms: Mucous in nasal passage in the mornings
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 | Increased upper airway secretion | · | · | ✓ |
| SD | Nasal congestion | · | · | ✓ |
| SD | Throat clearing | · | · | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
| SRO | Rash | · | · | ✓ |
| SRO | Somnolence | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release