2JW-31603-10392

2 vaccinations 5 coded responses 22 check-ins 5 free-text entries 2 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 967 / HI
Registered: 2021-04-09

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

2021-04-09
Registered in v-safe
2021-04-09
Dose 1 — Moderna
2021-04-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Abdominal pain

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Abdominal pain

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Abdominal pain

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Abdominal pain

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Joint pains, Muscle or body aches, Abdominal pain

Adult check-in
2021-04-16
Health check-in — day 7, dose 1
Feeling: Good · Joint pains, Muscle or body aches, Abdominal pain

Adult check-in
2021-04-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-30
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-07
Dose 2 — Moderna
2021-05-07
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Abdominal pain

Adult check-in
2021-05-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-05-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-05-10
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain lower — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: Feel really horrible on this second shot really sore left lower abdomen

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-05-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-05-14
Survey response — day 7, dose 2
MedDRA: Abdominal pain — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: Really sore left abdominal pain afternoons around 4:30 pm and off on throughout the days ?!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-28
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-12
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-18
Survey response — day 42, dose 2
MedDRA: Cardiac disorder, Delirium, Pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Body wont stop aching and heart and brain problems all of a sudden i didnt have these problems two months ago spot found in my brain and heart possibly blood clot just turned a heart monitor in today so waiting on results very unhappy not g

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-08
Survey response — 3 months, dose 2
MedDRA: Atrial fibrillation, Cardiomegaly, Cerebral thrombosis, Heart rate irregular, Office visit — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Symptoms: Blood clot on my brain an possibly four types of cancer found waiting on blood test to confirm results since 4/09/2021 completely changed my life Im dying it seems in two and a half months a fib enlarged heart irregular heartbeat and know wats nex · Healthcare visit (other): Private drs

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-08
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-05
Survey response — 6 months, dose 2
MedDRA: Cerebrovascular accident, Fall, Heart rate irregular, Lymphoma, Plasma cell myeloma — Feeling: Poor · 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, Emergency room or emergency department visit

Free text: Irregular heartbeat multiple myeloma men's disease lymphoma and 2 dna flaws stroke and fell down 5 days after my second shot so I'm dying pretty much after those vaccines I received so I'm not ok at all it's documented by my drs (b)(6) Univerity

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Report sent to call center — 6 months, dose 2
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 · Emergency room or emergency department visit · 1 call case(s)
2021-11-08
Call 1 — Requested Callback
2021-11-09
Callback requested for
02:00PM ET
2021-11-10
Call 2 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-09	Moderna
2	2021-05-07	Moderna

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 8 — days 1–6 daily, dose 2

2021-05-10

Systemic reaction (other): Feel really horrible on this second shot really sore left lower abdomen

Release 8 — day 7, dose 2

2021-05-14

Systemic reaction (other): Really sore left abdominal pain afternoons around 4:30 pm and off on throughout the days ?!

Release 9 — day 42, dose 2

2021-06-18

Symptoms: Body wont stop aching and heart and brain problems all of a sudden i didnt have these problems two months ago spot found in my brain and heart possibly blood clot just turned a heart monitor in today so waiting on results very unhappy not g

Release 9 — 3 months, dose 2

2021-08-08

Symptoms: Blood clot on my brain an possibly four types of cancer found waiting on blood test to confirm results since 4/09/2021 completely changed my life Im dying it seems in two and a half months a fib enlarged heart irregular heartbeat and know wats nex

Healthcare visit (other): Private drs

Release 10 — 6 months, dose 2

2021-11-05

Symptoms: Irregular heartbeat multiple myeloma men's disease lymphoma and 2 dna flaws stroke and fell down 5 days after my second shot so I'm dying pretty much after those vaccines I received so I'm not ok at all it's documented by my drs (b)(6) Univerity

redacted (b)(6)

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	✓	·	✓
SD	Atrial fibrillation	✓	·	✓
SD	Cardiac disorder	✓	✓	✓
SD	Cardiomegaly	✓	·	✓
SD	Cerebral thrombosis	✓	·	✓
SD	Cerebrovascular accident	·	·	✓
SD	Delirium	✓	✓	✓
SD	Fall	·	·	✓
SD	Heart rate irregular	✓	·	✓
SD	Lymphoma	·	·	✓
SD	Pain	✓	✓	✓
SD	Plasma cell myeloma	·	·	✓
SRO	Abdominal pain	✓	✓	✓
SRO	Abdominal pain lower	✓	✓	✓

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