3JE-15764-06354

4 vaccinations 9 coded responses 48 check-ins 9 free-text entries 5 call cases

Sex: Male
Age at first dose: 31-35
ZIP prefix: 900 / CA
Registered: 2021-02-19

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

2021-02-19
Registered in v-safe
2021-02-19
Dose 1 — Pfizer-BioNTech
2021-02-19
Health check-in — day 0, dose 1
Feeling: Good · Headache

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Abdominal pain

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

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Diarrhea

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-26
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-12
Dose 2 — Pfizer-BioNTech
2021-03-12
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-03-14
Survey response — days 1–6 daily, dose 2
MedDRA: Blood glucose increased, Type 1 diabetes mellitus — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Past 24 hours - type 1 diabetes - higher BGs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Eye pain, Pain, Swelling of eyelid — Feeling: Fair · Headache

Free text: Pain in left ocular ridge; pain when moving left eye; slight swelling of left eye area.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Eye pain — Feeling: Good · Headache

Free text: Minor pain in left ocular region

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-03-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-02
Survey response — day 21, dose 2
MedDRA: Acupuncture, Diarrhoea — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Diarrhea · Healthcare visit (other): Acupuncture

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-10
Call 1 — Could Not Reach Participant
2021-06-11
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-10
Survey response — 6 months, dose 2
MedDRA: Conjunctival haemorrhage, Eye haemorrhage, Pharyngitis streptococcal — Feeling: Good · Be unable to work or attend school, 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

Free text: Strep throat; eye - blood vessel break in retina and sub conjunctival hemorrhage post injection.

MedDRA releases: 2024-11 · check-in free text available
2021-09-10
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-09-13
Call 2 — Requested Callback
2021-09-14
Callback requested for
2021-09-14
Call successful
Not applicable - Accidental Reporting
2021-12-09
Dose 3 — Moderna
2021-12-10
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-12-12
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-12-13
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-15
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-17
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-23
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-30
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-06
Survey response — day 28, dose 3
MedDRA: Body temperature increased, Chest discomfort, Cough, Medical counselling, Nasal congestion, Oropharyngeal pain, Rhinorrhoea — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Sore throat similar to strep (swallowing razors feeling); low grade fever (99.1~); minor stuffy/runny nose; small cough; minor chest pressure. · Healthcare visit (other): Cruise ship medical

MedDRA releases: 2024-11 · check-in free text available
2022-01-06
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-01-11
Call 1 — Left Voicemail
2022-01-12
Call 2 — Left Voicemail
2022-01-13
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-13
Call 3 — Could Not Reach Participant
2022-01-14
Callback requested for
2022-01-14
Call successful
Not applicable - Accidental Reporting
2022-01-22
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-11
Survey response — 3 months, dose 3
MedDRA: Vitreous haemorrhage — Feeling: Good · 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: Vitreous hemorrhage

MedDRA releases: 2024-11 · check-in free text available
2022-03-11
Report sent to call center — 3 months, 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)
2022-03-14
Call successful
Not applicable - Accidental Reporting
2022-06-09
Survey response — 6 months, dose 3
MedDRA: Vitreous haemorrhage — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Recurrent vitreous hemorrhage.

MedDRA releases: 2024-11 · check-in free text available
2022-06-09
Report sent to call center — 6 months, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-10
Call 2 — Left Voicemail
2022-06-10
Call 1 — Left Voicemail
2022-06-10
Call X — Left Voicemail
2022-06-10
Call 1 — Left Voicemail
2022-06-10
Call 1 — Left Voicemail
2022-06-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-19
Dose 4 — Moderna
2022-10-19
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-10-20
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-21
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-10-22
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-26
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-11-03
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-09
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-16
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-23
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-30
Survey response — day 42, dose 4
MedDRA: Nasopharyngitis, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Fair

Free text: Cold symptoms 5 days ago - stuffy, runny, sore throat. Continue testing negative on Covid and already about 90% improved.

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-19	Pfizer-BioNTech
2	2021-03-12	Pfizer-BioNTech
3	2021-12-09	Moderna	No
4	2022-10-19	Moderna	No

Call center

5 call center cases

5 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-14

Systemic reaction (other): Past 24 hours - type 1 diabetes - higher BGs

2021-03-15

Systemic reaction (other): Pain in left ocular ridge; pain when moving left eye; slight swelling of left eye area.

2021-03-16

Systemic reaction (other): Minor pain in left ocular region

Release 6 — day 21, dose 2

2021-04-02

Symptoms: Diarrhea

Healthcare visit (other): Acupuncture

Release 9 — 6 months, dose 2

2021-09-10

Symptoms: Strep throat; eye - blood vessel break in retina and sub conjunctival hemorrhage post injection.

Release 10 — day 28, dose 3

2022-01-06

Symptoms: Sore throat similar to strep (swallowing razors feeling); low grade fever (99.1~); minor stuffy/runny nose; small cough; minor chest pressure.

Healthcare visit (other): Cruise ship medical

Release 11 — 3 months, dose 3

2022-03-11

Symptoms: Vitreous hemorrhage

Release 12 — 6 months, dose 3

2022-06-09

Symptoms: Recurrent vitreous hemorrhage.

Release 12 — day 42, dose 4

2022-11-30

Symptoms: Cold symptoms 5 days ago - stuffy, runny, sore throat. Continue testing negative on Covid and already about 90% improved.

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	Acupuncture	✓	✓	✓
HCVO	Medical counselling	·	·	✓
SD	Body temperature increased	·	·	✓
SD	Chest discomfort	·	·	✓
SD	Conjunctival haemorrhage	·	·	✓
SD	Cough	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Eye haemorrhage	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pharyngitis streptococcal	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Vitreous haemorrhage	·	·	✓
SRO	Blood glucose increased	✓	✓	✓
SRO	Eye pain	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Swelling of eyelid	✓	✓	✓
SRO	Type 1 diabetes mellitus	✓	✓	✓

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