2PH-33673-67627

2 vaccinations 7 coded responses 23 check-ins 7 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 658 / MO
Registered: 2021-02-07

Relationship: Self
Race: N/A
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-06
Dose 1 — Moderna
2021-02-07
Registered in v-safe
2021-02-07
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Fair · Site: Pain

Free text: (b)(6) has Alzheimers and this morning when I dropped him off for coffee he became confused when time to call home for pickup. I called him to see if he was OK because past his usual pickup time. He told me he was on his way home. His cousin was bringing him home. I waited 20 minutes as he was only five minutes away. When I called him the second time he was angry because he had called me. I called his cousin to find out what happened. He shared that (b)(6) was not himself and he had heard (b)(6) tell me that he as bringing him home. His cousin said he went out to the auto to take (b)(6) home but that (b)(6) didnt follow as he usually would have one. The cousin said he went back inside to get (b)(6) but was told my wife is coming to get me. When I got (b)(6) home he sore he had called me twice and he never said he was going to let his cousin drive him home. (b)(6) son was going to take him to an indoor golf driving range for his birthday but (b)(6) said he wasnt up to it. May not have anything to do with vaccine but thought I would share.

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: No adverse event — Feeling: Good · Site: Pain

Free text: None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-21
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-06
Dose 2 — Moderna
2021-03-06
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Fatigue or tiredness

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-03-10
Survey response — days 1–6 daily, dose 2
MedDRA: Agitation, Anger — Feeling: Good

Free text: Just more angry and agitated than usual

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: Agitation — Feeling: Good · Muscle or body aches

Free text: His agitation is still present and am wondering if this might have something to do with the Covid vaccine

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: Agitation, Somnolence — Feeling: Good · Muscle or body aches

Free text: Still sleeping a lot but agitation is still an issue. Not as bad as previous but we think it might be connected to the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Survey response — day 7, dose 2
MedDRA: Agitation — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: Agitation appears some better but sleeping more today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — day 14, dose 2
MedDRA: Blood pressure increased, Dyspnoea, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Not sure if it has to do with Covid vaccine but the dr is doing further tests. Shortness of breathe and periods of elevated BP. · Healthcare visit (other): Routine 6 month checkup

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-28
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-03
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-17
Health check-in — day 42, dose 2
Feeling: Good

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

Adult check-in
2021-09-06
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-28
Call 2 — Could Not Reach Participant
2022-01-03
Call 1 — Left Voicemail
2022-03-08
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-06	Moderna
2	2021-03-06	Moderna

Call center

1 call center case

1 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-07

Systemic reaction (other): (b)(6) has Alzheimers and this morning when I dropped him off for coffee he became confused when time to call home for pickup. I called him to see if he was OK because past his usual pickup time. He told me he was on his way home. His cousin was bringing him home. I waited 20 minutes as he was only five minutes away. When I called him the second time he was angry because he had called me. I called his cousin to find out what happened. He shared that (b)(6) was not himself and he had heard (b)(6) tell me that he as bringing him home. His cousin said he went out to the auto to take (b)(6) home but that (b)(6) didnt follow as he usually would have one. The cousin said he went back inside to get (b)(6) but was told my wife is coming to get me. When I got (b)(6) home he sore he had called me twice and he never said he was going to let his cousin drive him home. (b)(6) son was going to take him to an indoor golf driving range for his birthday but (b)(6) said he wasnt up to it. May not have anything to do with vaccine but thought I would share.

redacted (b)(6)

2021-02-09

Systemic reaction (other): None

Release 5 — days 1–6 daily, dose 2

2021-03-10

Systemic reaction (other): Just more angry and agitated than usual

2021-03-11

Systemic reaction (other): His agitation is still present and am wondering if this might have something to do with the Covid vaccine

2021-03-12

Systemic reaction (other): Still sleeping a lot but agitation is still an issue. Not as bad as previous but we think it might be connected to the vaccine.

Release 5 — day 7, dose 2

2021-03-13

Systemic reaction (other): Agitation appears some better but sleeping more today.

Release 6 — day 14, dose 2

2021-03-20

Symptoms: Not sure if it has to do with Covid vaccine but the dr is doing further tests. Shortness of breathe and periods of elevated BP.

Healthcare visit (other): Routine 6 month checkup

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	Blood pressure increased	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SRO	Agitation	✓	✓	✓
SRO	Anger	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Somnolence	✓	✓	✓

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