3FH-17957-59014

3 vaccinations 8 coded responses 33 check-ins 8 free-text entries 3 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 802 / CO
Registered: 2021-01-21

Relationship: Self
Race: N/A
Ethnicity: N/A

Timeline

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

2021-01-21
Registered in v-safe
2021-01-21
Dose 1 — Moderna
2021-01-21
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: I also hav had these symptoms from before getting tha vaccine so it is hard to lame it I the vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
Survey response — days 1–6 daily, dose 1
MedDRA: Adverse reaction — Feeling: Fair · Fever · Chills, Muscle or body aches · Be unable to do your normal daily activities

Free text: I already had some other illness. Can t tell where symptoms are from

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Survey response — days 1–6 daily, dose 1
MedDRA: Hospitalisation — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: I am in the hospital with another condition

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Hospitalisation, Pericardial effusion, Unevaluable event — Feeling: Fair · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Systemic reaction (other): I also have an ongoing percardina effusion going and am in the hispital · Healthcare visit (other): Probably not due to vaccination

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-28
Survey response — day 7, dose 1
MedDRA: Hospitalisation, Pericardial effusion, Pre-existing disease — Feeling: Fair · Headache · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Systemic reaction (other): I am hospitalized for pericardial effusion right now · Healthcare visit (other): I have been very ill for reasons other than my vaccination

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Report sent to call center — day 7, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-11
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-16
Dose 2 — Moderna
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-04
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-16
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-23
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-18
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-06-08
Call 1 — Left Voicemail
2021-08-17
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-22
Dose 3 — Moderna
2021-10-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Musculoskeletal stiffness — Feeling: Fair · Joint pains

Free text: Stiff neck which may be due to non COVID sources.

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Survey response — day 7, dose 3
MedDRA: Neck pain — Feeling: Good · Muscle or body aches

Free text: Neck pain- may be unrelated to Covid

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-12
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-04
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-21
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-22
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-22
Survey response — 12 months, dose 3
MedDRA: Pneumothorax, Rib fracture, Road traffic accident, Scapula fracture — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Bike accident. 8 broken ribs, scapula fracture and punctured lung. None of this is Covid related

MedDRA releases: 2024-11 · check-in free text available
2022-10-22
Report sent to call center — 12 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-10-25
Call successful
Does not wish to fill out VAERS report
2022-10-25
Call successful
Does not wish to fill out VAERS report
2022-10-25
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Moderna
2	2021-02-16	Moderna
3	2021-10-22	Moderna	No

Call center

3 call center cases

3 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-22

Systemic reaction (other): I also hav had these symptoms from before getting tha vaccine so it is hard to lame it I the vaccine

2021-01-24

Systemic reaction (other): I already had some other illness. Can t tell where symptoms are from

2021-01-26

Systemic reaction (other): I am in the hospital with another condition

2021-01-27

Systemic reaction (other): I also have an ongoing percardina effusion going and am in the hispital

Healthcare visit (other): Probably not due to vaccination

Release 2 — day 7, dose 1

2021-01-28

Systemic reaction (other): I am hospitalized for pericardial effusion right now

Healthcare visit (other): I have been very ill for reasons other than my vaccination

Release 10 — days 1–6 daily, dose 3

2021-10-28

Systemic reaction (other): Stiff neck which may be due to non COVID sources.

Release 10 — day 7, dose 3

2021-10-30

Systemic reaction (other): Neck pain- may be unrelated to Covid

Release 12 — 12 months, dose 3

2022-10-22

Symptoms: Bike accident. 8 broken ribs, scapula fracture and punctured lung. None of this is Covid related

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	Pre-existing disease	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Pneumothorax	·	·	✓
SD	Rib fracture	·	·	✓
SD	Road traffic accident	·	·	✓
SD	Scapula fracture	·	·	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Hospitalisation	✓	✓	✓
SRO	Musculoskeletal stiffness	·	·	✓
SRO	Neck pain	·	·	✓
SRO	Pericardial effusion	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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