2K4-18318-01667

3 vaccinations 6 coded responses 33 check-ins 6 free-text entries 1 call case

Sex: Male
Age at first dose: 51-55
ZIP prefix: 557 / MN
Registered: 2021-05-05

Relationship: Self
Race: White
Ethnicity: N/A

Timeline

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

2021-05-04
Dose 1 — Moderna
2021-05-05
Registered in v-safe
2021-05-05
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Muscle or body aches

Adult check-in
2021-05-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fever · Muscle or body aches

Adult check-in
2021-05-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-05-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-25
Survey response — day 21, dose 1
MedDRA: Emergency care, Hypotension, Loss of consciousness — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: I'm had hypotension to the extent that I lost consciousness and went to emergency medicine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-25
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-01
Dose 2 — Moderna
2021-06-01
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-06-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-06-03
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-06-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-06-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-06-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-06-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-06-08
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-06-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-29
Survey response — day 28, dose 2
MedDRA: Pre-existing disease, Tachycardia — Feeling: Good

Free text: Tachycardia, I haven't visited a doctor but part of my regular cardiac monitoring. Probably related to medication changes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-06
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-07-13
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-31
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-11-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-01-31
Dose 3 — Moderna
2022-01-31
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · 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

Adult check-in
2022-02-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-02-02
Survey response — days 1–6 daily, dose 3
MedDRA: Pre-existing disease — Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: I have central sensitivity disorder which makes it difficult to differentiate a reaction. But I think I'm having a symptomatic reaction.

MedDRA releases: 2024-11 · check-in free text available
2022-02-03
Survey response — days 1–6 daily, dose 3
MedDRA: Feeling abnormal — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Feeling back to normal

MedDRA releases: 2024-11 · check-in free text available
2022-02-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-02-05
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-02-06
Survey response — days 1–6 daily, dose 3
MedDRA: Anxiety, Irritability — Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Anxious and crabby, which probably aren't related. Have a nice day!

MedDRA releases: 2024-11 · check-in free text available
2022-02-07
Health check-in — day 7, dose 3
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-02-14
Survey response — day 14, dose 3
MedDRA: Feeling hot, Influenza, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities

Free text: I have been feeling more fluish or feverish but I haven't have a fever. I do not believe this is a result of the vaccine nor do I believe that I have COVID. It's probably related to underlying health conditions.

MedDRA releases: 2024-11 · check-in free text available
2022-02-14
Call 1 — Left Voicemail
2022-02-14
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-04	Moderna
2	2021-06-01	Moderna
3	2022-01-31	Moderna	No

Call center

1 call center case

1 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 8 — day 21, dose 1

2021-05-25

Symptoms: I'm had hypotension to the extent that I lost consciousness and went to emergency medicine.

Release 9 — day 28, dose 2

2021-06-29

Symptoms: Tachycardia, I haven't visited a doctor but part of my regular cardiac monitoring. Probably related to medication changes

Release 11 — days 1–6 daily, dose 3

2022-02-02

Systemic reaction (other): I have central sensitivity disorder which makes it difficult to differentiate a reaction. But I think I'm having a symptomatic reaction.

2022-02-03

Systemic reaction (other): Feeling back to normal

2022-02-06

Systemic reaction (other): Anxious and crabby, which probably aren't related. Have a nice day!

Release 11 — day 14, dose 3

2022-02-14

Symptoms: I have been feeling more fluish or feverish but I haven't have a fever. I do not believe this is a result of the vaccine nor do I believe that I have COVID. It's probably related to underlying health conditions.

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	Emergency care	✓	✓	✓
SD	Feeling hot	·	·	✓
SD	Hypotension	✓	✓	✓
SD	Influenza	·	·	✓
SD	Loss of consciousness	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Tachycardia	✓	✓	✓
SRO	Anxiety	·	·	✓
SRO	Feeling abnormal	·	·	✓
SRO	Irritability	·	·	✓
SRO	Pre-existing disease	·	·	✓

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