3KS-21111-44413

3 vaccinations 6 coded responses 38 check-ins 6 free-text entries 2 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 958 / CA
Registered: 2021-02-09

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
Registered in v-safe
2021-02-09
Dose 1 — Moderna
2021-02-09
Health check-in — day 0, dose 1
Feeling: Fair · Muscle or body aches

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

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: Fair · Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-02-16
Survey response — day 7, dose 1
MedDRA: Depression — Feeling: Poor · Fever · Headache, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: It is likely symptoms of my battle with depression rather than the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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
2021-03-09
Dose 2 — Moderna
2021-03-09
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-16
Survey response — day 7, dose 2
MedDRA: Chest discomfort, Cough, Nasopharyngitis — Feeling: Fair · Fever · Muscle or body aches, Fatigue or tiredness

Free text: Felt like a mild cold last night. Mild cough and tightness in chest

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-06
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-13
Survey response — day 35, dose 2
MedDRA: Hypoaesthesia, Mobility decreased, Pain in extremity — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Pain and numbness and lack of response in my lower left leg and foot. Waiting on a call from advi e nurse.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-08
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-07
Survey response — 6 months, dose 2
MedDRA: Nerve injury, Peroneal nerve palsy — Feeling: Poor · Be unable to do your normal daily activities

Free text: Not related to Covid. Nerve injury and drop foot.

MedDRA releases: 2024-11 · check-in free text available
2021-10-25
Dose 3 — Moderna
Co-administered: yes
2021-10-25
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Joint pains

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fever · Chills, Joint pains, Muscle or body aches

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-02
Health check-in — day 7, dose 3
Feeling: Fair · None

Adult check-in
2021-11-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-15
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-22
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-11-29
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-06
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
2022-04-25
Survey response — 6 months, dose 3
MedDRA: Influenza, SARS-CoV-2 test negative — 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

Free text: Symptoms: Had a month long flu but tested negative for Covid in the middle of it · Healthcare visit (other): Went in for Covid test. Negative

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Report sent to call center — 6 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-04-26
Call 1 — Left Voicemail
2022-10-25
Survey response — 12 months, dose 3
MedDRA: Depression, Lethargy, Sleep deficit — 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 · Telehealth, virtual health, or email health consultation

Free text: Depression, Lethargy, Sleep deprivation,

MedDRA releases: 2024-11 · check-in free text available
2022-10-25
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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-26
Call 2 — Left Voicemail
2022-10-26
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Moderna
2	2021-03-09	Moderna
3	2021-10-25	Moderna	Yes

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 4 — day 7, dose 1

2021-02-16

Systemic reaction (other): It is likely symptoms of my battle with depression rather than the vaccine.

Release 5 — day 7, dose 2

2021-03-16

Systemic reaction (other): Felt like a mild cold last night. Mild cough and tightness in chest

Release 7 — day 35, dose 2

2021-04-13

Symptoms: Pain and numbness and lack of response in my lower left leg and foot. Waiting on a call from advi e nurse.

Release 9 — 6 months, dose 2

2021-09-07

Symptoms: Not related to Covid. Nerve injury and drop foot.

Release 11 — 6 months, dose 3

2022-04-25

Symptoms: Had a month long flu but tested negative for Covid in the middle of it

Healthcare visit (other): Went in for Covid test. Negative

Release 12 — 12 months, dose 3

2022-10-25

Symptoms: Depression, Lethargy, Sleep deprivation,

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	SARS-CoV-2 test negative	·	·	✓
SD	Depression	·	·	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Influenza	·	·	✓
SD	Lethargy	·	·	✓
SD	Mobility decreased	✓	✓	✓
SD	Nerve injury	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Peroneal nerve palsy	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sleep deficit	·	·	✓
SRO	Chest discomfort	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Depression	✓	✓	✓
SRO	Nasopharyngitis	✓	✓	✓

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