Y7Q-30825-49586
2 vaccinations
2 coded responses
23 check-ins
2 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 46-50
- ZIP prefix
- 313 / GA
- Registered
- 2021-03-08
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-08
Registered in v-safe
-
2021-03-08
Dose 1 — Moderna
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-12
- 2021-03-13
- 2021-03-14
- 2021-03-15
-
2021-03-22
Survey response — day 14, dose 1MedDRA: Fall, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Symptoms: Craig had a unwitnessed fall, thought to be syncope. He has had 3 previous events like this prior to vaccine · Healthcare visit (other): Craig recently diagnosed with dementia This diagnosis was prior to vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-22
Report sent to call center — day 14, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-03-29
- 2021-04-05
-
2021-04-08
Dose 2 — Moderna
- 2021-04-12
- 2021-04-13
- 2021-04-14
- 2021-04-15
- 2021-04-22
- 2021-04-29
- 2021-05-06
- 2021-05-13
- 2021-05-20
- 2021-07-08
- 2021-10-07
-
2021-12-14
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-04-08
Survey response — 12 months, dose 2MedDRA: COVID-19, Condition aggravated, Living in residential institution, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: (b)(6) Alzheimer's Disease has progressed He is currently residing in a nursing home He got Covid within month of first residing there but thanks to vaccines he has mild symptoms and did well · Healthcare visit (other): In patient care from his nursing homeMedDRA releases: 2024-11 · check-in free text available
-
2022-04-08
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2022-04-13
- 2022-04-15
-
2022-04-15
Callback requested for10:00AM ET
-
2022-04-15
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-08 | Moderna | |
| 2 | 2021-04-08 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-03-22 | Successful 2021-12-14 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2022-04-08 | Successful 2022-04-15 |
Does not wish to fill out VAERS report |
Free text
Release 6 — day 14, dose 1
Symptoms: Craig had a unwitnessed fall, thought to be syncope. He has had 3 previous events like this prior to vaccine
Healthcare visit (other): Craig recently diagnosed with dementia This diagnosis was prior to vaccine
Release 11 — 12 months, dose 2
Symptoms: (b)(6) Alzheimer's Disease has progressed He is currently residing in a nursing home He got Covid within month of first residing there but thanks to vaccines he has mild symptoms and did well
Healthcare visit (other): In patient care from his nursing home
redacted (b)(6)
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 | Living in residential institution | · | · | ✓ |
| HCVO | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Fall | ✓ | ✓ | ✓ |
| SD | Living in residential institution | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release