35D-10177-85625

3 vaccinations 13 coded responses 31 check-ins 13 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 927 / CA
Registered: 2021-03-06

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Timeline

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

2021-03-05
Dose 1 — Moderna
2021-03-06
Registered in v-safe
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-07
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Pain in extremity — Feeling: Fair · Site: Pain

Free text: Light headiness , arm a little sorer today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Good · Site: Pain

Free text: A little light headed

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

Adult check-in
2021-03-10
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair

Free text: Very light headed

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

Free text: Light headef & sore right arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — day 7, dose 1
MedDRA: Dizziness — Feeling: Good · Muscle or body aches

Free text: Light headed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-02
Dose 2 — Moderna
2021-04-09
Survey response — day 7, dose 2
MedDRA: Back pain, Sneezing — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Anytime I sneeze I get a mild sharp pain lower back left side facing you

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-23
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-30
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-05
Survey response — 3 months, dose 2
MedDRA: Visual field defect, Vitreous floaters — Feeling: Fair · Be unable to do your normal daily activities

Free text: Vision , losing some peripheral vision & seeing floaters

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-01
Survey response — 6 months, dose 2
MedDRA: Balance disorder, Dizziness — Feeling: Fair · Be unable to do your normal daily activities

Free text: Dizziness , feel like Equilibrium is off

MedDRA releases: 2024-11 · check-in free text available
2021-10-26
Dose 3 — Moderna
2021-10-26
Survey response — day 0, dose 3
MedDRA: Paraesthesia — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Free text: Hand & knee tingling

MedDRA releases: 2024-11 · check-in free text available
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: Pain, Pre-existing disease — Feeling: Fair · Site: Pain · Joint pains

Free text: Right knee seems more sore then usual

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Arthralgia, Pain in extremity — Feeling: Fair · Site: Pain · Joint pains

Free text: Left shoulder now sore with right arm

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Arthralgia, Muscle spasms — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Calf keeps cramping , knee extremely painful

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Health check-in — day 7, dose 3
Feeling: Good · Joint pains

Adult check-in
2021-11-09
Survey response — day 14, dose 3
MedDRA: Arthritis infective, Oropharyngeal pain, Respiratory tract congestion — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Sore throat, conjested , infection of knee · Healthcare visit (other): Knee seemed infected

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Report sent to call center — day 14, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-15
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-16
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-25
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-07
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-26
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-26
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-05	Moderna
2	2021-04-02	Moderna
3	2021-10-26	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-07

Systemic reaction (other): Light headiness , arm a little sorer today

2021-03-08

Systemic reaction (other): A little light headed

2021-03-10

Systemic reaction (other): Very light headed

2021-03-11

Systemic reaction (other): Light headef & sore right arm

Release 5 — day 7, dose 1

2021-03-12

Systemic reaction (other): Light headed

Release 7 — day 7, dose 2

2021-04-09

Systemic reaction (other): Anytime I sneeze I get a mild sharp pain lower back left side facing you

Release 9 — 3 months, dose 2

2021-07-05

Symptoms: Vision , losing some peripheral vision & seeing floaters

Release 9 — 6 months, dose 2

2021-10-01

Symptoms: Dizziness , feel like Equilibrium is off

Release 10 — day 0, dose 3

2021-10-26

Systemic reaction (other): Hand & knee tingling

Release 10 — days 1–6 daily, dose 3

2021-10-27

Systemic reaction (other): Right knee seems more sore then usual

2021-10-28

Systemic reaction (other): Left shoulder now sore with right arm

2021-10-31

Systemic reaction (other): Calf keeps cramping , knee extremely painful

Release 10 — day 14, dose 3

2021-11-09

Symptoms: Sore throat, conjested , infection of knee

Healthcare visit (other): Knee seemed infected

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	Arthritis infective	·	·	✓
SD	Arthritis infective	·	·	✓
SD	Balance disorder	·	·	✓
SD	Dizziness	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Visual field defect	✓	✓	✓
SD	Vitreous floaters	✓	✓	✓
SRO	Arthralgia	·	·	✓
SRO	Back pain	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Muscle spasms	·	·	✓
SRO	Pain	·	·	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Paraesthesia	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Sneezing	✓	✓	✓

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