Z4K-19865-54997
4 vaccinations
5 coded responses
52 check-ins
4 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 080 / NJ
- Registered
- 2020-12-24
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-24
Registered in v-safe
-
2020-12-24
Dose 1 — Moderna
- 2020-12-25
- 2020-12-26
- 2020-12-27
- 2020-12-28
- 2020-12-29
- 2020-12-30
- 2020-12-31
-
2021-01-07
Survey response — day 14, dose 1MedDRA: Abdominal discomfort, Abdominal pain upper — Feeling: FairFree text: Severe stomach pain. Two of us had the same lunch yesterday. Only I had issues. I am not sure if lunch may have. caused it. Don't want to jump to conclusions. Pain today is more discomfort.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-16
-
2021-01-21
Dose 2 — Moderna
-
2021-01-22
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-01-24
- 2021-01-25
- 2021-01-26
- 2021-01-27
- 2021-01-28
- 2021-02-04
- 2021-02-11
- 2021-02-18
- 2021-02-25
- 2021-03-04
- 2021-04-22
- 2021-07-24
-
2021-10-29
Dose 3 — Moderna
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-05
- 2021-11-12
- 2021-11-19
-
2021-11-26
Survey response — day 28, dose 3MedDRA: Arthralgia — Feeling: FairFree text: Shoulder joint painMedDRA releases: 2024-11 · check-in free text available
- 2021-12-04
- 2021-12-11
- 2022-01-28
- 2022-05-01
-
2022-06-10
Dose 4 — Moderna
-
2022-06-11
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Chills, Fatigue or tirednessAdult check-in
- 2022-06-12
- 2022-06-13
- 2022-06-14
- 2022-06-15
- 2022-06-16
-
2022-06-17
Survey response — day 7, dose 4MedDRA: Cough — Feeling: Poor · Headache, Muscle or body aches, Fatigue or tirednessFree text: CoughMedDRA releases: 2024-11 · check-in free text available
- 2022-06-24
- 2022-07-02
- 2022-07-08
- 2022-07-15
-
2022-07-22
Survey response — day 42, dose 4MedDRA: Conjunctivitis, Fatigue, Laryngitis, Lymphadenopathy, Oropharyngeal pain, Productive cough, Sputum discoloured — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Coughing up green mucus. Sore throat. Swollen nodules in cheeks. Very tired. Took rapid test yesterday and today. Both negative. A bit better today than yesterday. Started with laryngitis Wednesday afternoon. Right eye slightly pink.MedDRA releases: 2024-11 · check-in free text available
- 2022-09-10
- 2022-12-09
-
2023-06-10
Survey response — 12 months, dose 4MedDRA: Bronchitis — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-06-10
Call case (no matching report) — SuccessfulDoes not wish to fill out VAERS report
-
2023-06-12
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-24 | Moderna | |
| 2 | 2021-01-21 | Moderna | |
| 3 | 2021-10-29 | Moderna | No |
| 4 | 2022-06-10 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2023-06-10 | Successful 2023-06-12 |
Does not wish to fill out VAERS report |
Free text
Release 1 — day 14, dose 1
Symptoms: Severe stomach pain. Two of us had the same lunch yesterday. Only I had issues. I am not sure if lunch may have. caused it. Don't want to jump to conclusions. Pain today is more discomfort.
Release 10 — day 28, dose 3
Symptoms: Shoulder joint pain
Release 12 — day 7, dose 4
Systemic reaction (other): Cough
Release 12 — day 42, dose 4
Symptoms: Coughing up green mucus. Sore throat. Swollen nodules in cheeks. Very tired. Took rapid test yesterday and today. Both negative. A bit better today than yesterday. Started with laryngitis Wednesday afternoon. Right eye slightly pink.
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 | Abdominal discomfort | ✓ | ✓ | ✓ |
| SD | Abdominal pain upper | ✓ | ✓ | ✓ |
| SD | Arthralgia | · | · | ✓ |
| SD | Bronchitis | · | · | ✓ |
| SD | Conjunctivitis | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Laryngitis | · | · | ✓ |
| SD | Lymphadenopathy | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Productive cough | · | · | ✓ |
| SD | Sputum discoloured | · | · | ✓ |
| SRO | Cough | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release