22T-23294-01848

5 vaccinations 8 coded responses 49 check-ins 7 free-text entries 1 call case

Sex: Male
Age at first dose: 51-55
ZIP prefix: 547 / WI
Registered: 2021-01-29

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-01-14
Dose 1 — Moderna
2021-01-29
Registered in v-safe
2021-01-29
Survey response — day 14, dose 1
MedDRA: Injection site pruritus, Injection site rash — Feeling: Fair

Free text: Circular rash (2 inch diameter) and itchiness developed at injection site on 24 Jan2021.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-11
Dose 2 — Moderna
2021-02-11
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal discomfort, Decreased appetite — Feeling: Fair · Abdominal pain

Free text: Abdominal discomfort and reduced appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-04
Survey response — day 21, dose 2
MedDRA: Headache — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-25
Survey response — day 42, dose 2
MedDRA: Bowel movement irregularity, Diarrhoea, Frequent bowel movements, Gastrointestinal pain — Feeling: Good

Free text: Since COVID-19 vaccinations, experiencing irregular bowel movements, more frequent, and looser with some mild cramping. Don't know if coincidental or related to the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Survey response — 3 months, dose 2
MedDRA: Cough, Illness, Nasopharyngitis, Respiratory tract congestion, SARS-CoV-2 test negative — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Extremely severe cold (?). Onset of symptoms 16 days ago. Still experiencing a cough and chest congestion. Excessive and very hard cough was the worst symptom during spell of illness. Tested negative for COVID-19 3 times during spell of illness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-12
Survey response — 6 months, dose 2
MedDRA: Cough — Feeling: Fair · Be unable to do your normal daily activities

Free text: Have experienced a very bad cough on 3 occasions since vaccination. Duration has been over week all 3 times. Cough similar to a cough associated with the common cold but significantly more intense.This cough was not normal for me prior to vaccination

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-22
Dose 3 — Moderna
2021-11-23
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-11-24
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-26
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-11-29
Health check-in — day 7, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-12-06
Survey response — day 14, dose 3
MedDRA: Cough, Fatigue, Headache, Myalgia, Respiratory tract congestion — Feeling: Poor · Be unable to work or attend school

Free text: Severe congestion, harsh cough, headache, muscle aches, and fatigue.

MedDRA releases: 2024-11 · check-in free text available
2021-12-13
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-12-20
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-27
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2022-01-03
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-02-21
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-06-07
Dose 4 — Moderna
2022-06-07
Health check-in — day 0, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-06-08
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-06-10
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Itching · Fatigue or tiredness

Adult check-in
2022-06-11
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Itching · None

Adult check-in
2022-06-13
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Itching · None

Adult check-in
2022-06-15
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-06-21
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-28
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-07-05
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-07-14
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-19
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-09-06
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-11
Dose 5 — Moderna
2022-10-12
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Muscle or body aches, Nausea

Adult check-in
2022-10-13
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-10-17
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-10-18
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2022-10-25
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-11-02
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-09
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-16
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-22
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-11
Survey response — 3 months, dose 5
MedDRA: Blood pressure increased — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-01-11
Report sent to call center — 3 months, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-01-12
Call 1 — Left Voicemail
2023-01-12
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-12
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-11	Moderna
3	2021-11-22	Moderna	No
4	2022-06-07	Moderna	No
5	2022-10-11	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 3 — day 14, dose 1

2021-01-29

Symptoms: Circular rash (2 inch diameter) and itchiness developed at injection site on 24 Jan2021.

Release 4 — days 1–6 daily, dose 2

2021-02-15

Systemic reaction (other): Abdominal discomfort and reduced appetite

Release 5 — day 21, dose 2

2021-03-04

Symptoms: Headache

Release 6 — day 42, dose 2

2021-03-25

Symptoms: Since COVID-19 vaccinations, experiencing irregular bowel movements, more frequent, and looser with some mild cramping. Don't know if coincidental or related to the vaccine.

Release 8 — 3 months, dose 2

2021-05-13

Symptoms: Extremely severe cold (?). Onset of symptoms 16 days ago. Still experiencing a cough and chest congestion. Excessive and very hard cough was the worst symptom during spell of illness. Tested negative for COVID-19 3 times during spell of illness.

Release 9 — 6 months, dose 2

2021-08-12

Symptoms: Have experienced a very bad cough on 3 occasions since vaccination. Duration has been over week all 3 times. Cough similar to a cough associated with the common cold but significantly more intense.This cough was not normal for me prior to vaccination cut off by CDC

Release 10 — day 14, dose 3

2021-12-06

Symptoms: Severe congestion, harsh cough, headache, muscle aches, and fatigue.

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	Blood pressure increased	·	·	✓
SD	Bowel movement irregularity	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Frequent bowel movements	✓	✓	✓
SD	Gastrointestinal pain	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Illness	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Myalgia	·	·	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓

✓ active code · ○ coded but marked inactive · blank = not in that release