YJV-18373-55798
2 vaccinations
8 coded responses
15 check-ins
8 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 56-60
- ZIP prefix
- 967 / HI
- Registered
- 2021-04-30
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-30
Dose 1 — Moderna
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2021-04-29
Dose 2 — Moderna
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2021-04-30
Registered in v-safe
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2021-04-30
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
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2021-05-01
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
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2021-05-02
Survey response — days 1–6 daily, dose 2MedDRA: Pre-existing disease — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activitiesFree text: I routinely deal with low grade fevers, nausea, body aches, headaches etc due to (b)(6)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-03
Survey response — days 1–6 daily, dose 2MedDRA: Pain in extremity, Pre-existing disease, Tenderness — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work, Be unable to do your normal daily activitiesFree text: I think these are the usual symptoms from (b)(6). Aside from sire arm and extra tiredness I think I'm past the vaccine side effectsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-04
Survey response — days 1–6 daily, dose 2MedDRA: Unevaluable event — Feeling: Fair · Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: I think items checked are from (b)(6) not vacvineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-05
Survey response — days 1–6 daily, dose 2MedDRA: Unevaluable event — Feeling: Fair · Joint pains, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activitiesFree text: The symptoms above are typical if my day fighting (b)(6). I do not believe I am having further vaccine effectsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-06
Survey response — day 7, dose 2MedDRA: Pre-existing disease — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activitiesFree text: These are due to my (b)(6). I do not believe I am having vaccine side effectsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-13
- 2021-05-20
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2021-05-28
Survey response — day 28, dose 2MedDRA: Agitation, Anxiety — Feeling: Fair · Be unable to work, Be unable to do your normal daily activitiesFree text: Extreme agitation and anxiety, related to antidepressant I have been on for yearsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-03
Survey response — day 35, dose 2MedDRA: Anxiety, Dehydration, Panic attack — Feeling: Fair · Be unable to work, Be unable to do your normal daily activitiesFree text: Extreme anxiety and panic attacks probably unrelated you vaccine, but to Wellbutrin and dehydrationMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-06-10
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2021-07-29
Survey response — 3 months, dose 2MedDRA: Tooth infection — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Infected toothMedDRA releases: 2021-09,2024-11 · check-in free text available
- 2021-10-28
- 2022-04-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-30 | Moderna | |
| 2 | 2021-04-29 | Moderna |
Free text
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): I routinely deal with low grade fevers, nausea, body aches, headaches etc due to (b)(6)
redacted (b)(6)
Systemic reaction (other): I think these are the usual symptoms from (b)(6). Aside from sire arm and extra tiredness I think I'm past the vaccine side effects
redacted (b)(6)
Systemic reaction (other): I think items checked are from (b)(6) not vacvine
redacted (b)(6)
Systemic reaction (other): The symptoms above are typical if my day fighting (b)(6). I do not believe I am having further vaccine effects
redacted (b)(6)
Release 8 — day 7, dose 2
Systemic reaction (other): These are due to my (b)(6). I do not believe I am having vaccine side effects
redacted (b)(6)
Release 8 — day 28, dose 2
Symptoms: Extreme agitation and anxiety, related to antidepressant I have been on for years
Release 8 — day 35, dose 2
Symptoms: Extreme anxiety and panic attacks probably unrelated you vaccine, but to Wellbutrin and dehydration
Release 9 — 3 months, dose 2
Symptoms: Infected tooth
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 | Agitation | ✓ | ✓ | ✓ |
| SD | Anxiety | ✓ | ✓ | ✓ |
| SD | Dehydration | ✓ | ✓ | ✓ |
| SD | Panic attack | ✓ | ✓ | ✓ |
| SD | Tooth infection | ✓ | · | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Tenderness | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release