23G-20295-28033

5 vaccinations 21 coded responses 62 check-ins 20 free-text entries 9 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 147 / NY
Registered: 2021-01-30

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

2021-01-29
Dose 1 — Moderna
2021-01-30
Registered in v-safe
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Abdominal pain

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Abdominal pain

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Diarrhea, Abdominal pain

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Abdominal pain

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — day 7, dose 1
Feeling: Good · Abdominal pain

Adult check-in
2021-02-12
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-25
Dose 2 — Moderna
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Nasal congestion — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Fatigue or tiredness, Abdominal pain

Free text: cough, stuffiness but not runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Nasopharyngitis, Respiratory tract congestion, Self-medication, Throat irritation — Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness

Free text: like im starting to get a cold, stuffiness, throat feels irritated, been taking Claritin and ibuprofen

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Nasopharyngitis, Pulmonary pain, Rhinorrhoea, Throat irritation — Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: have what really feels like a head cold, Have runny nose and irritated throat, slight cough, lower right lung hurt when coughing which got better tonight

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Rhinorrhoea, Throat irritation — Feeling: Fair · Site: Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Free text: Runny Nose and irritated throat have ceased, cough has been more of an issue, and its deep in the lungs, hurts my ribs to cough, overall feeling better than yesterday, went to work today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — day 7, dose 2
MedDRA: Antibiotic therapy, COVID-19, Cough, Lung disorder, Medical counselling, Pulmonary pain, Respiratory tract congestion — Feeling: Fair · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Continue with Stuffiness, however the cough and lung pain has increased, called my doctor, he wants a Covid test and xray, and put me on antibotic for cough and lung issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Report sent to call center — day 7, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-11
Survey response — day 14, dose 2
MedDRA: Chest pain, Cough, Medical counselling — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: cough and chest pain, Dr gave me an antibiotic

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-27
Survey response — day 28, dose 2
MedDRA: Cough, Dyspnoea — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: dry cough and a little breathless

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-03
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-27
Survey response — 3 months, dose 2
MedDRA: Atrial flutter — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Hospitalization

Free text: I have had to have a catheter ablation for an atrial flutter.This occurred out of the blue without having any real issues leading up to it

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Report sent to call center — 3 months, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-28
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-07
Call 3 — Left Voicemail
2021-10-07
Call 1 — Left Voicemail
2021-10-07
Call 1 — Left Voicemail
2021-10-07
Call 1 — Left Voicemail
2021-11-06
Dose 3 — Moderna
Co-administered: Flu
2021-11-06
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · None

Adult check-in
2021-11-07
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Rhinorrhoea — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Runny nose and cough

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Survey response — days 1–6 daily, dose 3
MedDRA: SARS-CoV-2 test, SARS-CoV-2 test positive — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches · Be unable to work or attend school, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Tested positive for Covid today · Healthcare visit (other): Covid test site

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Report sent to call center — days 1–6 daily, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-09
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-11-09
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-11-09
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-11
Survey response — days 1–6 daily, dose 3
MedDRA: SARS-CoV-2 test positive — Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Tested positive fir Covid on Monday the 8th, had monochonal antibodies Wednesday 11/10

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Survey response — days 1–6 daily, dose 3
MedDRA: COVID-19 — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Covid positive; monochonal antibodies seemed to really help in last 48 hrs

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Survey response — day 7, dose 3
MedDRA: Office visit, Oral candidiasis — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work or attend school

Free text: Thrush in my mouth / throatDr prescribed rinse

MedDRA releases: 2024-11 · check-in free text available
2021-11-20
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-28
Survey response — day 21, dose 3
MedDRA: Cough, Fatigue, Quarantine — Feeling: Fair · Be unable to do your normal daily activities

Free text: Coughing is ridiculous And exhaustion Out of quarantine but these are hanging in there

MedDRA releases: 2024-11 · check-in free text available
2021-11-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-12-04
Survey response — day 28, dose 3
MedDRA: Cough, Fatigue, Lung opacity, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Cough Exhaustion Lungs showing some broken glass · Healthcare visit (other): X-rays

MedDRA releases: 2024-11 · check-in free text available
2021-12-04
Report sent to call center — day 28, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-07
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-11
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-18
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-02-05
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-05-07
Survey response — 6 months, dose 3
MedDRA: Brain fog, Fatigue, Headache, Memory impairment, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I continue to feel fatigue And definitely having a covid fog situation on remembering things Also headaches · Healthcare visit (other): Dr visit

MedDRA releases: 2024-11 · check-in free text available
2022-05-07
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-09
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-25
Dose 4 — Moderna
2022-05-25
Survey response — day 0, dose 4
MedDRA: Amnesia — Feeling: Fair · Fatigue or tiredness

Free text: Loss of memory

MedDRA releases: 2024-11 · check-in free text available
2022-05-26
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2022-05-27
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness

Adult check-in
2022-05-28
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness

Adult check-in
2022-05-29
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness

Adult check-in
2022-05-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness

Adult check-in
2022-05-31
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Redness · Headache, Fatigue or tiredness

Adult check-in
2022-06-01
Survey response — day 7, dose 4
MedDRA: Heart rate increased — Feeling: Poor · Site: Swelling · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Rapid heart rate

MedDRA releases: 2024-11 · check-in free text available
2022-06-08
Survey response — day 14, dose 4
MedDRA: Fatigue, Headache, Tachycardia — Feeling: Fair

Free text: Has head aches Had bouts of tachycardia And Fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-06-15
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-22
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-29
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-06
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-08-25
Survey response — 3 months, dose 4
MedDRA: Arthropathy, Brain fog, Fatigue, Office visit, Physiotherapy — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Having a lot of joint issues And fatigue and brian fog · Healthcare visit (other): Regular dr visits and PT

MedDRA releases: 2024-11 · check-in free text available
2022-08-25
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-08-26
Call 2 — Left Voicemail
2022-08-26
Call 2 — Left Voicemail
2022-10-25
Dose 5 — Moderna
Co-administered: Flu
2022-10-26
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fever · Chills, Joint pains

Adult check-in
2022-10-28
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Redness · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-29
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-30
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Headache, Joint pains

Adult check-in
2022-10-31
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-11-01
Health check-in — day 7, dose 5
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-11-08
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-11-16
Health check-in — day 21, dose 5
Feeling: Fair

Adult check-in
2022-11-22
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-30
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-12-06
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-24
Health check-in — 3 months, dose 5
Feeling: Fair

Adult check-in
2023-04-27
Survey response — 6 months, dose 5
MedDRA: Arrhythmia, Blood pressure abnormal, Cardiac disorder, Dyspnoea, Fatigue, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-04-27
Report sent to call center — 6 months, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2023-04-28
Call 1 — Left Voicemail
2023-04-28
Call 1 — Left Voicemail
2023-04-28
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-29	Moderna
2	2021-02-25	Moderna
3	2021-11-06	Moderna	Flu
4	2022-05-25	Moderna	No
5	2022-10-25	Moderna	Flu

Call center

9 call center cases

6 successful · 3 unsuccessful

4 waits over 3 months for a first call

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-28

Systemic reaction (other): cough, stuffiness but not runny nose

2021-03-01

Systemic reaction (other): like im starting to get a cold, stuffiness, throat feels irritated, been taking Claritin and ibuprofen

2021-03-02

Systemic reaction (other): have what really feels like a head cold, Have runny nose and irritated throat, slight cough, lower right lung hurt when coughing which got better tonight

2021-03-03

Systemic reaction (other): Runny Nose and irritated throat have ceased, cough has been more of an issue, and its deep in the lungs, hurts my ribs to cough, overall feeling better than yesterday, went to work today

Release 5 — day 7, dose 2

2021-03-04

Systemic reaction (other): Continue with Stuffiness, however the cough and lung pain has increased, called my doctor, he wants a Covid test and xray, and put me on antibotic for cough and lung issues

Release 5 — day 14, dose 2

2021-03-11

Symptoms: cough and chest pain, Dr gave me an antibiotic

Release 6 — day 28, dose 2

2021-03-27

Symptoms: dry cough and a little breathless

Release 8 — 3 months, dose 2

2021-05-27

Symptoms: I have had to have a catheter ablation for an atrial flutter.This occurred out of the blue without having any real issues leading up to it

Release 10 — days 1–6 daily, dose 3

2021-11-07

Systemic reaction (other): Runny nose and cough

2021-11-08

Systemic reaction (other): Tested positive for Covid today

Healthcare visit (other): Covid test site

2021-11-11

Systemic reaction (other): Tested positive fir Covid on Monday the 8th, had monochonal antibodies Wednesday 11/10

2021-11-12

Systemic reaction (other): Covid positive; monochonal antibodies seemed to really help in last 48 hrs

Release 10 — day 7, dose 3

2021-11-13

Systemic reaction (other): Thrush in my mouth / throatDr prescribed rinse

Release 10 — day 21, dose 3

2021-11-28

Symptoms: Coughing is ridiculous And exhaustion Out of quarantine but these are hanging in there

Release 10 — day 28, dose 3

2021-12-04

Symptoms: Cough Exhaustion Lungs showing some broken glass

Healthcare visit (other): X-rays

Release 11 — 6 months, dose 3

2022-05-07

Symptoms: I continue to feel fatigue And definitely having a covid fog situation on remembering things Also headaches

Healthcare visit (other): Dr visit

Release 11 — day 0, dose 4

2022-05-25

Systemic reaction (other): Loss of memory

Release 11 — day 7, dose 4

2022-06-01

Systemic reaction (other): Rapid heart rate

Release 11 — day 14, dose 4

2022-06-08

Symptoms: Has head aches Had bouts of tachycardia And Fatigue

Release 12 — 3 months, dose 4

2022-08-25

Symptoms: Having a lot of joint issues And fatigue and brian fog

Healthcare visit (other): Regular dr visits and PT

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	Office visit	·	·	✓
HCVO	Physiotherapy	·	·	✓
HCVO	SARS-CoV-2 test	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Arrhythmia	·	·	✓
SD	Arthropathy	·	·	✓
SD	Atrial flutter	✓	✓	✓
SD	Blood pressure abnormal	·	·	✓
SD	Brain fog	·	·	✓
SD	Cardiac disorder	·	·	✓
SD	Chest pain	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Lung opacity	·	·	✓
SD	Medical counselling	✓	✓	✓
SD	Memory impairment	·	·	✓
SD	Office visit	·	·	✓
SD	Quarantine	·	·	✓
SD	Tachycardia	·	·	✓
SRO	Amnesia	·	·	✓
SRO	Antibiotic therapy	✓	✓	○
SRO	Cough	✓	✓	✓
SRO	COVID-19	✓	✓	✓
SRO	Heart rate increased	·	·	✓
SRO	Lung disorder	·	·	✓
SRO	Medical counselling	·	·	✓
SRO	Nasal congestion	✓	✓	✓
SRO	Nasopharyngitis	✓	✓	✓
SRO	Office visit	·	·	✓
SRO	Oral candidiasis	·	·	✓
SRO	Pulmonary pain	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	SARS-CoV-2 test positive	·	·	✓
SRO	Self-medication	✓	✓	✓
SRO	Throat irritation	✓	✓	✓

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