ZKV-66753-19580
5 vaccinations
11 coded responses
38 check-ins
11 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 51-55
- ZIP prefix
- 629 / IL
- Registered
- 2021-12-02
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-28
Dose 1 — Moderna
-
2021-03-10
Dose 2 — Moderna
-
2021-12-02
Registered in v-safe
-
2021-12-02
Dose 3 — Moderna
- 2021-12-02
-
2021-12-03
Survey response — days 1–6 daily, dose 3MedDRA: Dyspnoea, Hypoaesthesia, Paraesthesia — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body achesFree text: Slight tingling, loss of sensation in each pinky, shortness of breathMedDRA releases: 2024-11 · check-in free text available
- 2021-12-04
- 2021-12-05
- 2021-12-06
-
2021-12-07
Survey response — days 1–6 daily, dose 3MedDRA: Vertigo — Feeling: Fair · Fatigue or tirednessFree text: Brief vertigo this morning, 2hrs in durationMedDRA releases: 2024-11 · check-in free text available
- 2021-12-08
- 2021-12-09
-
2021-12-16
Survey response — day 14, dose 3MedDRA: Cough, Rhinorrhoea — Feeling: GoodFree text: Dry cough runny noseMedDRA releases: 2024-11 · check-in free text available
-
2021-12-23
Survey response — day 21, dose 3MedDRA: Abnormal weight gain — Feeling: FairFree text: Abnormal weight gain. 10 lbs in less than a week with no change to diet or exercisingMedDRA releases: 2024-11 · check-in free text available
- 2021-12-30
-
2022-01-06
Survey response — day 35, dose 3MedDRA: Cough, Fatigue, Increased upper airway secretion, Rhinorrhoea, Sneezing — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Runny nose, coughing, sneezing, drainage in throat, fatigue.MedDRA releases: 2024-11 · check-in free text available
- 2022-01-14
- 2022-03-03
-
2022-05-19
Dose 4 — Moderna
-
2022-05-19
Health check-in — day 0, dose 4Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Fatigue or tiredness, DiarrheaAdult check-in
-
2022-05-20
Survey response — days 1–6 daily, dose 4MedDRA: Respiratory tract congestion — Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tirednessFree text: CongestionMedDRA releases: 2024-11 · check-in free text available
- 2022-05-21
-
2022-05-23
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2022-05-24
- 2022-05-25
- 2022-05-26
- 2022-06-04
- 2022-06-09
- 2022-06-16
- 2022-06-23
- 2022-06-30
-
2022-08-18
Survey response — 3 months, dose 4MedDRA: Pre-existing disease — Feeling: FairFree text: Seasonal allergiesMedDRA releases: 2024-11 · check-in free text available
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2022-09-09
Dose 5 — Moderna
- 2022-09-09
-
2022-09-11
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Pain · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2022-09-12
Survey response — days 1–6 daily, dose 5MedDRA: Confusional state — Feeling: Poor · Be unable to work or attend schoolFree text: Mild confusionMedDRA releases: 2024-11 · check-in free text available
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2022-09-13
Survey response — days 1–6 daily, dose 5MedDRA: Dysphagia, Gallbladder disorder, Pain, Pain in jaw, Toothache — Feeling: Poor · Site: Pain · Be unable to work or attend schoolFree text: Severe what felt like a gall bladder attack after eating nothing the night before. This was at 3AM. 9 out of 10 pain. Difficulty swallowing. Resolved by noon, but almost had to go to ER. Pain so bad jaw and teeth hurt.MedDRA releases: 2024-11 · check-in free text available
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2022-09-16
Survey response — day 7, dose 5MedDRA: Confusional state, Dysphemia, Transient ischaemic attack — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Mild confusion, stuttering, suspected mild TIA pending testsMedDRA releases: 2024-11 · check-in free text available
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2022-09-23
Survey response — day 14, dose 5MedDRA: Emergency care, Transient ischaemic attack — Feeling: Good · Be unable to work or attend schoolFree text: Diagosed TIA as of September 21, 2022 resulting in 911 call and hospital treatment.MedDRA releases: 2024-11 · check-in free text available
- 2022-09-30
- 2022-10-07
- 2022-10-14
- 2022-10-24
- 2022-12-10
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-28 | Moderna | No |
| 2 | 2021-03-10 | Moderna | No |
| 3 | 2021-12-02 | Moderna | No |
| 4 | 2022-05-19 | Moderna | No |
| 5 | 2022-09-09 | Moderna | No |
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Slight tingling, loss of sensation in each pinky, shortness of breath
Systemic reaction (other): Brief vertigo this morning, 2hrs in duration
Release 10 — day 14, dose 3
Symptoms: Dry cough runny nose
Release 10 — day 21, dose 3
Symptoms: Abnormal weight gain. 10 lbs in less than a week with no change to diet or exercising
Release 10 — day 35, dose 3
Symptoms: Runny nose, coughing, sneezing, drainage in throat, fatigue.
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Congestion
Release 12 — 3 months, dose 4
Symptoms: Seasonal allergies
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): Mild confusion
Systemic reaction (other): Severe what felt like a gall bladder attack after eating nothing the night before. This was at 3AM. 9 out of 10 pain. Difficulty swallowing. Resolved by noon, but almost had to go to ER. Pain so bad jaw and teeth hurt.
Release 12 — day 7, dose 5
Systemic reaction (other): Mild confusion, stuttering, suspected mild TIA pending tests
Release 12 — day 14, dose 5
Symptoms: Diagosed TIA as of September 21, 2022 resulting in 911 call and hospital treatment.
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 | Abnormal weight gain | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Increased upper airway secretion | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SD | Transient ischaemic attack | · | · | ✓ |
| SRO | Confusional state | · | · | ✓ |
| SRO | Dysphagia | · | · | ✓ |
| SRO | Dysphemia | · | · | ✓ |
| SRO | Dyspnoea | · | · | ✓ |
| SRO | Gallbladder disorder | · | · | ✓ |
| SRO | Hypoaesthesia | · | · | ✓ |
| SRO | Pain | · | · | ✓ |
| SRO | Pain in jaw | · | · | ✓ |
| SRO | Paraesthesia | · | · | ✓ |
| SRO | Respiratory tract congestion | · | · | ✓ |
| SRO | Toothache | · | · | ✓ |
| SRO | Transient ischaemic attack | · | · | ✓ |
| SRO | Vertigo | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release