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Y3L-25443-14279

2 vaccinations 3 coded responses 15 check-ins 3 free-text entries 2 call cases
Sex
Male
Age at first dose
66+
ZIP prefix
339 / FL
Registered
2021-01-15
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-14
    Dose 1 — Moderna
  2. 2021-01-15
    Registered in v-safe
  3. 2021-01-15
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · None
    Adult check-in
  4. 2021-01-16
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · None
    Adult check-in
  5. 2021-01-17
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-01-19
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-01-21
    Health check-in — day 7, dose 1
    Feeling: Good · Site: Pain, Itching · None
    Adult check-in
  8. 2021-01-28
    Survey response — day 14, dose 1
    MedDRA: Nausea — Feeling: Fair
    Free text: Nausea this afternoon. Nothing til this episode
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-02-04
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  10. 2021-02-09
    Dose 2 — Moderna
  11. 2021-02-18
    Survey response — day 7, dose 2
    MedDRA: Aphasia, Chills, Emergency care, Hospitalisation, Memory impairment, Tremor — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization
    Free text: Ten hours after the shot I had severe chills and shakes. About 23 hours after the shot I experienced partial loss of speech function and memory impairment. Was taken to the ER. While waiting six hours for a room symptoms dissipated. Was kept in hospital through the 12th of February. EEG, EKG and MRI revealed no causes, and no link or disassociation with the vaccine.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-02-18
    Report sent to call center — day 7, dose 2
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  13. 2021-02-23
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  14. 2021-03-02
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  15. 2021-03-09
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  16. 2021-03-16
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-03-23
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  18. 2021-08-09
  19. 2021-08-12
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  20. 2022-02-09
    Survey response — 12 months, dose 2
    MedDRA: Sleep apnoea syndrome, Transient ischaemic attack — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Have been diagnosed with sleep apnea and told to use a c pap. All this still related to the ministroke I suffered the day after vaccine number two in feb 2021
    MedDRA releases: 2024-11 · check-in free text available
  21. 2022-02-09
    Report sent to call center — 12 months, dose 2
    Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  22. 2022-02-11

Vaccinations

DoseDateManufacturerCo-administered
12021-01-14Moderna
22021-02-09Moderna

Call center

ReportedOutcomeVAERS-related outcome
2021-02-18 Unsuccessful
2022-02-09 Unsuccessful

Free text

Release 2 — day 14, dose 1

2021-01-28

Symptoms: Nausea this afternoon. Nothing til this episode

Release 4 — day 7, dose 2

2021-02-18

Systemic reaction (other): Ten hours after the shot I had severe chills and shakes. About 23 hours after the shot I experienced partial loss of speech function and memory impairment. Was taken to the ER. While waiting six hours for a room symptoms dissipated. Was kept in hospital through the 12th of February. EEG, EKG and MRI revealed no causes, and no link or disassociation with the vaccine.

Release 11 — 12 months, dose 2

2022-02-09

Symptoms: Have been diagnosed with sleep apnea and told to use a c pap. All this still related to the ministroke I suffered the day after vaccine number two in feb 2021

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
SDNausea ✓ ✓ ✓
SDSleep apnoea syndrome · · ✓
SDTransient ischaemic attack · · ✓
SROAphasia ✓ ✓ ✓
SROChills ✓ ✓ ✓
SROEmergency care ✓ ✓ ✓
SROHospitalisation ✓ ✓ ✓
SROMemory impairment ✓ ✓ ✓
SROTremor ✓ ✓ ✓

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