ZFD-19358-11602
4 vaccinations
2 coded responses
41 check-ins
2 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 130 / NY
- Registered
- 2021-01-22
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-21
Dose 1 — Moderna
-
2021-01-22
Registered in v-safe
- 2021-01-22
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-01-26
- 2021-01-27
- 2021-01-28
- 2021-02-04
- 2021-02-11
-
2021-02-18
Dose 2 — Moderna
- 2021-02-18
-
2021-02-19
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Chills, Headache, Joint pains, Fatigue or tirednessAdult check-in
- 2021-02-20
- 2021-02-21
- 2021-02-22
- 2021-02-23
- 2021-02-24
- 2021-02-25
- 2021-03-04
- 2021-03-11
- 2021-03-18
- 2021-03-25
- 2021-04-01
- 2021-05-20
- 2021-08-19
-
2021-11-17
Dose 3 — Moderna
-
2022-02-18
Survey response — 12 months, dose 2MedDRA: Atrial fibrillation, Cardioversion, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: In the past I experienced atrial fibrillations which were treated using cardio version. My last cardio version was in September 2020. Three weeks ago I went back into a-fib and received another cardio version on February 9th. Heart rhythm now OK. · Healthcare visit (other): In hospital cardio version, no hospitalization required.MedDRA releases: 2024-11 · check-in free text available
-
2022-02-18
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2022-02-21
- 2022-02-24
-
2022-05-10
Dose 4 — Moderna
- 2022-05-10
- 2022-05-11
- 2022-05-12
- 2022-05-13
- 2022-05-14
- 2022-05-15
-
2022-05-16
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Fatigue or tiredness, DiarrheaAdult check-in
- 2022-05-17
- 2022-05-24
- 2022-05-31
- 2022-06-07
- 2022-06-14
- 2022-06-21
- 2022-08-09
-
2022-11-08
Survey response — 6 months, dose 4MedDRA: Cough, Respiratory disorder, Respiratory tract congestion, SARS-CoV-2 test negative — Feeling: GoodFree text: I experienced 2 plus weeks of a respiratory issue. Cough and chest congestion. No fever and negative COVID test.MedDRA releases: 2024-11 · check-in free text available
- 2023-05-10
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-21 | Moderna | |
| 2 | 2021-02-18 | Moderna | |
| 3 | 2021-11-17 | Moderna | No |
| 4 | 2022-05-10 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-02-18 | Unsuccessful |
Free text
Release 11 — 12 months, dose 2
Symptoms: In the past I experienced atrial fibrillations which were treated using cardio version. My last cardio version was in September 2020. Three weeks ago I went back into a-fib and received another cardio version on February 9th. Heart rhythm now OK. cut off by CDC
Healthcare visit (other): In hospital cardio version, no hospitalization required.
Release 12 — 6 months, dose 4
Symptoms: I experienced 2 plus weeks of a respiratory issue. Cough and chest congestion. No fever and negative COVID test.
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 | Cardioversion | · | · | ✓ |
| SD | Atrial fibrillation | · | · | ✓ |
| SD | Cardioversion | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Respiratory disorder | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release