353-29638-45793

3 vaccinations 9 coded responses 14 check-ins 9 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 342 / FL
Registered: 2021-01-04

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

2021-01-04
Registered in v-safe
2021-01-04
Dose 1 — Moderna
2021-01-04
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Chills, Muscle or body aches

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache

Adult check-in
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-08
Survey response — days 1–6 daily, dose 1
MedDRA: Disorientation — Feeling: Fair · Fatigue or tiredness

Free text: Mental disorientation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-09
Survey response — days 1–6 daily, dose 1
MedDRA: Disorientation — Feeling: Fair · Fatigue or tiredness

Free text: Disorientation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-10
Survey response — days 1–6 daily, dose 1
MedDRA: Disorientation — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Very disoriented mid afternoon feeling a little better

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-11
Survey response — day 7, dose 1
MedDRA: Lung disorder — Feeling: Good · Site: Itching

Free text: Requested chest exay Exam to detect any lung damage

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Survey response — day 14, dose 1
MedDRA: Fatigue, Myalgia, Pain — Feeling: Fair

Free text: Body aches muscle pain fatigue same old old

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Survey response — day 21, dose 1
MedDRA: COVID-19, Interstitial lung disease, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Symptoms: Have interstitial lung pneumonia diseaseTaking Azithromycin Z pack 6 250 mg tab2 today then 1 eachI have the Covid virus since December 6, 2020 · Healthcare visit (other): Primary care follow up appointment tomorrow Tuesday 1/26

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-01
Dose 2 — Moderna
2021-02-08
Survey response — day 7, dose 2
MedDRA: Magnetic resonance imaging, Peroneal nerve palsy — Feeling: Good

Free text: Developed drop foot had MRI today to assist diagnosis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — day 14, dose 2
MedDRA: Erythema, Joint swelling, Peripheral swelling — Feeling: Good

Free text: Right ankle , foot and lower leg swelling showing redness.Left leg drop foot syndrome is improving.Tested negative on both PCR and rapid test 213 on 2/13/21

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Call 1 — Could Not Reach Participant
2021-04-15
Call 2 — Left Voicemail
2021-08-02
Survey response — 6 months, dose 2
MedDRA: COVID-19 — Feeling: Good · 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: Got Covid virus December 6, 2020

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-02
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

1 call case(s)
2021-08-03
Call 1 — Left Voicemail
2021-08-23
Dose 3 — Moderna
2021-11-22
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-21
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-02-01	Moderna
3	2021-08-23	Moderna	No

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-08

Systemic reaction (other): Mental disorientation

2021-01-09

Systemic reaction (other): Disorientation

2021-01-10

Systemic reaction (other): Very disoriented mid afternoon feeling a little better

Release 1 — day 7, dose 1

2021-01-11

Systemic reaction (other): Requested chest exay Exam to detect any lung damage

Release 2 — day 14, dose 1

2021-01-18

Symptoms: Body aches muscle pain fatigue same old old

Release 2 — day 21, dose 1

2021-01-25

Symptoms: Have interstitial lung pneumonia diseaseTaking Azithromycin Z pack 6 250 mg tab2 today then 1 eachI have the Covid virus since December 6, 2020

Healthcare visit (other): Primary care follow up appointment tomorrow Tuesday 1/26

Release 3 — day 7, dose 2

2021-02-08

Systemic reaction (other): Developed drop foot had MRI today to assist diagnosis

Release 4 — day 14, dose 2

2021-02-15

Symptoms: Right ankle , foot and lower leg swelling showing redness.Left leg drop foot syndrome is improving.Tested negative on both PCR and rapid test 213 on 2/13/21

Release 9 — 6 months, dose 2

2021-08-02

Symptoms: Got Covid virus December 6, 2020

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	Unevaluable event	✓	✓	✓
SD	COVID-19	✓	✓	✓
SD	Erythema	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Interstitial lung disease	✓	✓	✓
SD	Joint swelling	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SRO	Disorientation	✓	✓	✓
SRO	Lung disorder	✓	✓	✓
SRO	Magnetic resonance imaging	✓	✓	✓
SRO	Peroneal nerve palsy	✓	✓	✓

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