ZSJ-16603-17609
2 vaccinations
6 coded responses
15 check-ins
6 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 46-50
- ZIP prefix
- 883 / NM
- Registered
- 2021-04-07
- Relationship
- Self
- Race
- N/A
- Ethnicity
- N/A
Timeline
-
2021-04-07
Registered in v-safe
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2021-04-07
Dose 1 — Moderna
- 2021-04-07
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2021-04-08
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-04-09
- 2021-04-10
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2021-07-07
Survey response — 3 months, dose 1MedDRA: Headache — Feeling: Poor · Be unable to work or attend schoolFree text: Headaches strong. Cause unknown. Started few weeks ago. Not everyday. Migraine perhaps. Worst last a day, two days at most. No prior history. No other symptoms, colds, etc. this year.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-07-21
Dose 2 — Moderna
- 2021-07-21
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2021-07-22
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
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2021-07-23
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body achesAdult check-in
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2021-07-24
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia, Pain in extremity — Feeling: Fair · Joint pains, Nausea, DiarrheaFree text: Left leg pain. Intermittent. Started 24hrs after injection. Lower leg plus tenderness in left knee joint.MedDRA releases: 2021-09,2024-11 · check-in free text available
- 2021-07-27
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2021-07-28
Survey response — day 7, dose 2MedDRA: Oropharyngeal pain — Feeling: GoodFree text: Sore throatMedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-08-04
Survey response — day 14, dose 2MedDRA: Asthenia, Chest pain, Fatigue — Feeling: FairFree text: Just seem to be less energetic overall and quicker to tire. Some chest pain not felt before when doing anything aerobic. Not severe and stops within moments of ceasing activity but never had it before.MedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-08-13
Survey response — day 21, dose 2MedDRA: Anxiety, Chest discomfort, Tension — Feeling: GoodFree text: Reported last time, but still feeling a little chest discomfort during vigorous activity.Tightness/tenseness mostly. Centered between pecs, not more left or right, no arm pain. Similar to feeling of anxiousness, but not anxious. New since vax.MedDRA releases: 2021-09,2024-11 · check-in free text available
- 2021-08-18
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2022-01-20
Survey response — 6 months, dose 2MedDRA: Cardiac failure acute, Implantable defibrillator insertion — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, HospitalizationFree text: Symptoms: Acute heart failure HFrEF 14%. Immediate ICD install Nov 2021 · Healthcare visit (other): ICD surgeryMedDRA releases: 2024-11 · check-in free text available
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2022-01-20
Report sent to call center — 6 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Hospitalization · 1 call case(s)
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2022-01-21
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-07 | Moderna | |
| 2 | 2021-07-21 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-01-20 | Successful 2022-01-21 |
Participant prefers to complete VAERS report online |
Free text
Release 9 — 3 months, dose 1
Symptoms: Headaches strong. Cause unknown. Started few weeks ago. Not everyday. Migraine perhaps. Worst last a day, two days at most. No prior history. No other symptoms, colds, etc. this year.
Release 9 — days 1–6 daily, dose 2
Systemic reaction (other): Left leg pain. Intermittent. Started 24hrs after injection. Lower leg plus tenderness in left knee joint.
Release 9 — day 7, dose 2
Systemic reaction (other): Sore throat
Release 9 — day 14, dose 2
Symptoms: Just seem to be less energetic overall and quicker to tire. Some chest pain not felt before when doing anything aerobic. Not severe and stops within moments of ceasing activity but never had it before.
Release 9 — day 21, dose 2
Symptoms: Reported last time, but still feeling a little chest discomfort during vigorous activity.Tightness/tenseness mostly. Centered between pecs, not more left or right, no arm pain. Similar to feeling of anxiousness, but not anxious. New since vax.
Release 10 — 6 months, dose 2
Symptoms: Acute heart failure HFrEF 14%. Immediate ICD install Nov 2021
Healthcare visit (other): ICD surgery
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 | Implantable defibrillator insertion | · | · | ✓ |
| SD | Anxiety | ✓ | · | ✓ |
| SD | Asthenia | ✓ | · | ✓ |
| SD | Cardiac failure acute | · | · | ✓ |
| SD | Chest discomfort | ✓ | · | ✓ |
| SD | Chest pain | ✓ | · | ✓ |
| SD | Fatigue | ✓ | · | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Implantable defibrillator insertion | · | · | ✓ |
| SD | Tension | ✓ | · | ✓ |
| SRO | Arthralgia | ✓ | · | ✓ |
| SRO | Oropharyngeal pain | ✓ | · | ✓ |
| SRO | Pain in extremity | ✓ | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release