298-77687-95217

2 vaccinations 10 coded responses 26 check-ins 10 free-text entries 0 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 920 / CA
Registered: 2021-02-06

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

Registered dependents

V5Y-12017-42702 Adult relative or friend · Female · 2021-09-05

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-02-05
Dose 1 — Moderna
2021-02-06
Registered in v-safe
2021-02-06
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: I dont know if the tiredness is from lack of sleep or the injection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Headache, Pre-existing disease, Sleep disorder — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Headache is most likely related to Osteoarthritis in the neck vertebrae. Tiredness most likely related to sleep interrupted by the headache.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal discomfort, Abdominal tenderness — Feeling: Good · Abdominal pain

Free text: Not sure about this but noticed mid afternoon some discomfort in the navel. I notice it only if applying light pressure. It surprised me.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Discomfort — Feeling: Good · Abdominal pain

Free text: Other than the weird mild annoying concern with the upper inside of my navel I feel fine.

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

Adult check-in
2021-02-12
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-26
Survey response — day 21, dose 1
MedDRA: Abdominal discomfort — Feeling: Fair

Free text: Abdominal discomfort. Not sure its related. I have not seen any such thing related to the vaccination reported online. If it persists I will be contacting my primary care physician.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-07
Dose 2 — Moderna
2021-03-07
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal discomfort — Feeling: Fair · Site: Swelling · Abdominal pain

Free text: Better to describe this as abdominal discomfort.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal distension, Discomfort — Feeling: Good · Site: Swelling · Abdominal pain

Free text: Not pain but discomfort, overly full feeling in the abdomen

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal discomfort — Feeling: Good

Free text: Still keeping an eye on the strange abdominal discomfort but seems to be heading in a better direction.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal discomfort — Feeling: Fair

Free text: Still having issues with abdominal discomfort albeit greatly diminished. Should it last through the weekend I will schedule a check with my primary physician.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-14
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-21
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-28
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-19
Health check-in — day 42, dose 2
Feeling: Good

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

Adult check-in
2021-09-05
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-03-07
Survey response — 12 months, dose 2
MedDRA: Aspergillus infection, Pneumonia, Staphylococcal infection — Feeling: Fair

Free text: Lung infection with Streptococcus aureus (Heavy) and mild Aspergillus lentil is. Streptococcus is currently being treated with Doxycycline and undergoing further testing.

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-07	Moderna

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-06

Systemic reaction (other): I dont know if the tiredness is from lack of sleep or the injection.

2021-02-07

Systemic reaction (other): Headache is most likely related to Osteoarthritis in the neck vertebrae. Tiredness most likely related to sleep interrupted by the headache.

2021-02-09

Systemic reaction (other): Not sure about this but noticed mid afternoon some discomfort in the navel. I notice it only if applying light pressure. It surprised me.

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Other than the weird mild annoying concern with the upper inside of my navel I feel fine.

Release 4 — day 21, dose 1

2021-02-26

Symptoms: Abdominal discomfort. Not sure its related. I have not seen any such thing related to the vaccination reported online. If it persists I will be contacting my primary care physician.

Release 5 — days 1–6 daily, dose 2

2021-03-09

Systemic reaction (other): Better to describe this as abdominal discomfort.

2021-03-10

Systemic reaction (other): Not pain but discomfort, overly full feeling in the abdomen

2021-03-11

Systemic reaction (other): Still keeping an eye on the strange abdominal discomfort but seems to be heading in a better direction.

2021-03-12

Systemic reaction (other): Still having issues with abdominal discomfort albeit greatly diminished. Should it last through the weekend I will schedule a check with my primary physician.

Release 11 — 12 months, dose 2

2022-03-07

Symptoms: Lung infection with Streptococcus aureus (Heavy) and mild Aspergillus lentil is. Streptococcus is currently being treated with Doxycycline and undergoing further testing.

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	Abdominal discomfort	✓	✓	✓
SD	Aspergillus infection	·	·	✓
SD	Pneumonia	·	·	✓
SD	Staphylococcal infection	·	·	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Abdominal distension	✓	✓	✓
SRO	Abdominal tenderness	✓	✓	✓
SRO	Discomfort	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Sleep disorder	✓	✓	✓

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