Y4Q-85755-82810
3 vaccinations
8 coded responses
37 check-ins
8 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 46-50
- ZIP prefix
- 940 / CA
- Registered
- 2021-04-12
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
PEU-26222-64140
Child or adolescent in my care · Female · 2021-11-21
WKH-51177-25599
Child or adolescent in my care · Male · 2021-11-21
Timeline
-
2021-04-12
Registered in v-safe
-
2021-04-12
Dose 1 — Moderna
- 2021-04-12
- 2021-04-13
- 2021-04-14
-
2021-04-15
Survey response — days 1–6 daily, dose 1MedDRA: Rhinorrhoea, Sneezing — Feeling: GoodFree text: Sneezing and runny nose started yesterday mid-dayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-16
- 2021-04-17
-
2021-04-26
Survey response — day 14, dose 1MedDRA: Asthenia, Pain — Feeling: GoodFree text: Some body aches and weakness for two days last week.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-03
-
2021-05-10
Dose 2 — Moderna
- 2021-05-10
-
2021-05-11
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-05-12
- 2021-05-13
- 2021-05-14
- 2021-05-15
- 2021-05-16
- 2021-05-17
- 2021-05-24
- 2021-05-31
- 2021-06-07
- 2021-06-14
- 2021-06-21
- 2021-08-09
- 2021-11-10
-
2021-11-29
Dose 3 — Moderna
-
2021-11-30
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend schoolAdult check-in
-
2021-12-01
Survey response — days 1–6 daily, dose 3MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessFree text: Swollen and tender glands in arm pits, especially under the arm that received the shotMedDRA releases: 2024-11 · check-in free text available
-
2021-12-02
Survey response — days 1–6 daily, dose 3MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Fair · HeadacheFree text: Tenderness and swelling in glands in arm pit under arm that received shotMedDRA releases: 2024-11 · check-in free text available
- 2021-12-03
-
2021-12-04
Survey response — days 1–6 daily, dose 3MedDRA: Heart rate increased — Feeling: GoodFree text: My resting heart rate is still elevated by approximately 5 bpm (5-10%)MedDRA releases: 2024-11 · check-in free text available
-
2021-12-05
Survey response — days 1–6 daily, dose 3MedDRA: Heart rate increased — Feeling: GoodFree text: Elevated resting heart rate by 5 bpmMedDRA releases: 2024-11 · check-in free text available
- 2021-12-06
- 2021-12-13
- 2021-12-20
- 2022-01-03
-
2022-01-10
Survey response — day 42, dose 3MedDRA: Fatigue, Lower respiratory tract congestion, Myalgia, Sinus congestion — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Persistent bronchial and sinus congestion, fatigue, and some muscle aches. Kids tested positive for Covid-19.MedDRA releases: 2024-11 · check-in free text available
- 2022-02-28
- 2022-05-31
-
2022-11-29
Survey response — 12 months, dose 3MedDRA: Nasopharyngitis — Feeling: PoorFree text: Currently have a cold (not COVID)MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-12 | Moderna | |
| 2 | 2021-05-10 | Moderna | |
| 3 | 2021-11-29 | Moderna | No |
Free text
Release 7 — days 1–6 daily, dose 1
Systemic reaction (other): Sneezing and runny nose started yesterday mid-day
Release 8 — day 14, dose 1
Symptoms: Some body aches and weakness for two days last week.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Swollen and tender glands in arm pits, especially under the arm that received the shot
Systemic reaction (other): Tenderness and swelling in glands in arm pit under arm that received shot
Systemic reaction (other): My resting heart rate is still elevated by approximately 5 bpm (5-10%)
Systemic reaction (other): Elevated resting heart rate by 5 bpm
Release 10 — day 42, dose 3
Symptoms: Persistent bronchial and sinus congestion, fatigue, and some muscle aches. Kids tested positive for Covid-19.
Release 12 — 12 months, dose 3
Symptoms: Currently have a cold (not COVID)
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 | Asthenia | ✓ | ✓ | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Lower respiratory tract congestion | · | · | ✓ |
| SD | Myalgia | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Pain | ✓ | ✓ | ✓ |
| SD | Sinus congestion | · | · | ✓ |
| SRO | Heart rate increased | · | · | ✓ |
| SRO | Lymph node pain | · | · | ✓ |
| SRO | Lymphadenopathy | · | · | ✓ |
| SRO | Rhinorrhoea | ✓ | ✓ | ✓ |
| SRO | Sneezing | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release