3JZ-91115-66612

4 vaccinations 5 coded responses 30 check-ins 5 free-text entries 1 call case

Sex: Male
Age at first dose: 61-65
ZIP prefix: 990 / WA
Registered: 2021-02-10

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

2021-02-09
Dose 1 — Moderna
2021-02-10
Registered in v-safe
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Injection site sore

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-12
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Fair · Fatigue or tiredness

Free text: Today I was very tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-02
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 · Site: Pain · Headache

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

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

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-20
Survey response — day 14, dose 2
MedDRA: Chills, Fatigue, Feeling abnormal, Headache, Pain, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: On Tuesday I had fevers and odd dreams along with chills and a headache,body aches, very tired and feeling off. Lasted at least 10 to 12 hours. Have been very tired ever since.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
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
2021-06-07
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-04
Survey response — 6 months, dose 2
MedDRA: Emergency care, Haematemesis, Hospitalisation, Ulcer haemorrhage — Feeling: Good · 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: Sudden first ever severe bleeding ulcer attack. Vomited blood clots. 24 hrs in hospital. Had ER visit and scope to find and fix issue. Had iron infusion before being released.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-04
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)
2021-10-07
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-06
Dose 3 — Moderna
2022-03-06
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-04-01
Dose 4 — Moderna
2022-05-08
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-13
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-01
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-03
Survey response — 6 months, dose 4
MedDRA: COVID-19 — Feeling: Fair · Be unable to do your normal daily activities

Free text: Positive for COVID-19 on 9-25-22

MedDRA releases: 2024-11 · check-in free text available
2023-04-01
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Moderna
2	2021-03-06	Moderna
3	2021-11-06	Moderna	No
4	2022-04-01	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Injection site sore

2021-02-12

Systemic reaction (other): Today I was very tired

Release 6 — day 14, dose 2

2021-03-20

Symptoms: On Tuesday I had fevers and odd dreams along with chills and a headache,body aches, very tired and feeling off. Lasted at least 10 to 12 hours. Have been very tired ever since.

Release 9 — 6 months, dose 2

2021-09-04

Symptoms: Sudden first ever severe bleeding ulcer attack. Vomited blood clots. 24 hrs in hospital. Had ER visit and scope to find and fix issue. Had iron infusion before being released.

Release 12 — 6 months, dose 4

2022-10-03

Symptoms: Positive for COVID-19 on 9-25-22

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
SD	Chills	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Emergency care	✓	·	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Haematemesis	✓	·	✓
SD	Headache	✓	✓	✓
SD	Hospitalisation	✓	·	✓
SD	Pain	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Ulcer haemorrhage	✓	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Injection site pain	✓	✓	✓

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