278-33484-50593

2 vaccinations 12 coded responses 22 check-ins 12 free-text entries 0 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 606 / IL
Registered: 2021-02-08

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-02-08
Registered in v-safe
2021-02-08
Dose 1 — Moderna
2021-02-08
Health check-in — day 0, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Urticaria — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Slight hives.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 1
MedDRA: Hyperaesthesia, Rash, Rash erythematous, Self-medication, Sensitive skin, Throat irritation, Urticaria — Feeling: Fair · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Scratchy throat. Intermittent hives: skin sensitive, increases reaction to minor external irritation. ( ie: shirt collar irritated the back of my neck, resulting in red rash. ) I am continuing to take Diphenhydramine .50mg / q6 hours, and Acetaminophen 1000 mg / q6 hours. )

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Survey response — days 1–6 daily, dose 1
MedDRA: Diarrhoea — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Some loose stool.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-14
Survey response — days 1–6 daily, dose 1
MedDRA: Irregular sleep phase, Restless legs syndrome, Throat irritation — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Free text: *Scratchy throat * irregular sleep * restless legs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — day 7, dose 1
MedDRA: Sleep disorder, Throat irritation — Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Free text: Scratchy throat / Erratic sleep

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — day 14, dose 1
MedDRA: Cold sweat, Headache, Urticaria — Feeling: Fair

Free text: Headache, Hives around throat, neck, with clammy skin. Hives on bicep of left arm, forearm of right.Possibly related:Had dental appt. 11 days. post first injection on 19 Feb.20212nd dose is schedule on Day 24, NOT Day 28. Should I reschedule????

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-03-04
Dose 2 — Moderna
2021-03-05
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Neck pain — Feeling: Good · Site: Pain, Swelling · Muscle or body aches

Free text: Neck and Lower back pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches · Be unable to work

Adult check-in
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Good · Site: Pain, Swelling · Joint pains, Muscle or body aches · Be unable to work

Free text: Mild dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Mild dizziness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-03-11
Survey response — day 7, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — day 14, dose 2
MedDRA: Fatigue — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Extreme fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-02
Survey response — day 28, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Chronic fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-15
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-05
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-08	Moderna
2	2021-03-04	Moderna

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Slight hives.

2021-02-11

Systemic reaction (other): Scratchy throat. Intermittent hives: skin sensitive, increases reaction to minor external irritation. ( ie: shirt collar irritated the back of my neck, resulting in red rash. ) I am continuing to take Diphenhydramine .50mg / q6 hours, and Acetaminophen 1000 mg / q6 hours. )

2021-02-12

Systemic reaction (other): Some loose stool.

2021-02-14

Systemic reaction (other): *Scratchy throat * irregular sleep * restless legs

Release 4 — day 7, dose 1

2021-02-15

Systemic reaction (other): Scratchy throat / Erratic sleep

Release 4 — day 14, dose 1

2021-02-22

Symptoms: Headache, Hives around throat, neck, with clammy skin. Hives on bicep of left arm, forearm of right.Possibly related:Had dental appt. 11 days. post first injection on 19 Feb.20212nd dose is schedule on Day 24, NOT Day 28. Should I reschedule????

Release 5 — days 1–6 daily, dose 2

2021-03-05

Systemic reaction (other): Neck and Lower back pain.

2021-03-07

Systemic reaction (other): Mild dizziness

2021-03-08

Systemic reaction (other): Mild dizziness.

Release 5 — day 7, dose 2

2021-03-11

Systemic reaction (other): Dizziness

Release 5 — day 14, dose 2

2021-03-18

Symptoms: Extreme fatigue.

Release 6 — day 28, dose 2

2021-04-02

Symptoms: Chronic 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	Cold sweat	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Urticaria	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Hyperaesthesia	✓	✓	✓
SRO	Irregular sleep phase	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Rash erythematous	✓	✓	✓
SRO	Restless legs syndrome	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Sensitive skin	✓	✓	✓
SRO	Sleep disorder	✓	✓	✓
SRO	Throat irritation	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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