3LV-33394-50058

5 vaccinations 19 coded responses 65 check-ins 18 free-text entries 8 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 539 / WI
Registered: 2021-03-31

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

2021-03-31
Registered in v-safe
2021-03-31
Dose 1 — Moderna
2021-03-31
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-04-02
Survey response — days 1–6 daily, dose 1
MedDRA: Hernia — Feeling: Fair · Site: Pain · Abdominal pain

Free text: Pre-Op Hernia

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

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-05
Survey response — days 1–6 daily, dose 1
MedDRA: Hernia — Feeling: Good · Abdominal pain

Free text: Soon-to-be-repaired Hernia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — days 1–6 daily, dose 1
MedDRA: Hernia — Feeling: Good · Abdominal pain

Free text: Hernia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-14
Survey response — day 14, dose 1
MedDRA: Hernia repair, Laparoscopic surgery, Surgery, Unevaluable event — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Post Op, Laproscopic Hernia Repair the morning of Wednesday, April 14, 2021. · Healthcare visit (other): Outpatient Day Surgery

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Report sent to call center — day 14, 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)
2021-04-21
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-28
Dose 2 — Moderna
2021-04-28
Survey response — day 0, dose 2
MedDRA: Surgery — Feeling: Fair · Fatigue or tiredness · Be unable to work

Free text: Recuperating from surgery on April 14, 2021

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Survey response — days 1–6 daily, dose 2
MedDRA: Hernia repair — Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Post-Op Hernia Repair (April 14, 2021)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Survey response — days 1–6 daily, dose 2
MedDRA: Body temperature abnormal — Feeling: Good · Site: Pain · Chills

Free text: Body temperature back to normal as of this morning.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-01
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Site: Pain · Be unable to do your normal daily activities

Free text: Recuperating from April 14 surgery.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Survey response — days 1–6 daily, dose 2
MedDRA: Surgery — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Slowly regaining more physical movement after surgery.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Working on becoming more physically active after April 14 surgery.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I increased my physical activity today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Survey response — day 7, dose 2
MedDRA: Asthenia, Surgery — Feeling: Good · Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Regaining more strength with more movement after April 14, 2021 operation.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-28
Survey response — 3 months, dose 2
MedDRA: Heat exhaustion, Impaired work ability, Office visit, Stress — Feeling: Fair · Be unable to work or attend school, 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: On Friday, July 23, 2021 I was sent home due to heat exhaustion. Today my primary care physician cleared me to return to work tomorrow, Thursday July 29. Infection was ruled out through blood work and physical examination. Life stress a factor.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-28
Report sent to call center — 3 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)
2021-07-30
Call X — Left Voicemail
2021-10-27
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-05
Dose 3 — Moderna
2021-11-05
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-11
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-11-14
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-19
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-26
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-03
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-10
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-17
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-04
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-05-06
Survey response — 6 months, dose 3
MedDRA: Fatigue, Office visit — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Tiredness · Healthcare visit (other): Primary Health Care Provider Clinic

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
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

1 call case(s)
2022-05-09
Call 1 — Could Not Reach Participant
2022-05-09
Call 1 — Could Not Reach Participant
2022-05-09
Call 1 — Could Not Reach Participant
2022-05-13
Call 2 — Could Not Reach Participant
2022-05-13
Call 2 — Could Not Reach Participant
2022-05-13
Call 2 — Could Not Reach Participant
2022-05-27
Dose 4 — Moderna
2022-05-27
Survey response — day 0, dose 4
MedDRA: Burnout syndrome, Home care, Sick leave — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): I've been diagnosed with psychological burn out. Since May 03, 2022 I have been on medical leave from work. My return to work date is yet to determined.. · Healthcare visit (other): An in home visit from a social worker with the local county human services department.

MedDRA releases: 2024-11 · check-in free text available
2022-05-27
Report sent to call center — day 0, dose 4
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)
2022-05-28
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-05-29
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · None

Adult check-in
2022-05-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-31
Survey response — days 1–6 daily, dose 4
MedDRA: Burnout syndrome, Office visit — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, 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: Systemic reaction (other): On medical leave diagnosed with psychological burn out. · Healthcare visit (other): Clinic of Primary Care Provider

MedDRA releases: 2024-11 · check-in free text available
2022-05-31
Report sent to call center — days 1–6 daily, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-31
Call 3 — Left Voicemail
2022-05-31
Call 3 — Left Voicemail
2022-05-31
Call 3 — Left Voicemail
2022-05-31
Call 1 — Left Voicemail
2022-05-31
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-31
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-31
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-31
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-01
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-06-01
Call successful
Not applicable - Accidental Reporting
2022-06-01
Call successful
Not applicable - Accidental Reporting
2022-06-02
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Joint pains, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Adult check-in
2022-06-02
Report sent to call center — days 1–6 daily, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-05
Health check-in — day 7, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-06-10
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-17
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-06-24
Survey response — day 28, dose 4
MedDRA: Office visit, Post-traumatic stress disorder — 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 · Outpatient clinic or urgent care clinic visit

Free text: PTSD. I consider this condition unrelated to the COVID vaccination. I have been seeing a therapist and physician for the PTSD.

MedDRA releases: 2024-11 · check-in free text available
2022-06-24
Report sent to call center — day 28, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-28
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-01
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-08
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-26
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-23
Dose 5 — Pfizer-BioNTech
Co-administered: Flu
2022-11-23
Health check-in — day 0, dose 5
Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness

Adult check-in
2022-11-24
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness

Adult check-in
2022-11-25
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-11-27
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-11-28
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-11-30
Health check-in — day 7, dose 5
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-12-07
Health check-in — day 14, dose 5
Feeling: Fair

Adult check-in
2022-12-16
Health check-in — day 21, dose 5
Feeling: Fair

Adult check-in
2022-12-21
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-12-28
Survey response — day 35, dose 5
MedDRA: Cataract, Macular degeneration, Office visit, Pre-existing disease — Feeling: Fair

Free text: This last week I had my annual eye exam. My cataracts have slightly progressed. The very beginning of macular degeneration has been newly diagnosed for me.

MedDRA releases: 2024-11 · check-in free text available
2023-01-04
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2023-05-26
Survey response — 6 months, dose 5
MedDRA: Office visit, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-05-26
Call case (no matching report) — Successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-05-30
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	2021-03-31	Moderna
2	2021-04-28	Moderna
3	2021-11-05	Moderna	No
4	2022-05-27	Moderna	No
5	2022-11-23	Pfizer-BioNTech	Flu

Call center

8 call center cases

8 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 1

2021-04-02

Systemic reaction (other): Pre-Op Hernia

2021-04-05

Systemic reaction (other): Soon-to-be-repaired Hernia

Release 7 — days 1–6 daily, dose 1

2021-04-06

Systemic reaction (other): Hernia

Release 7 — day 14, dose 1

2021-04-14

Symptoms: Post Op, Laproscopic Hernia Repair the morning of Wednesday, April 14, 2021.

Healthcare visit (other): Outpatient Day Surgery

Release 8 — day 0, dose 2

2021-04-28

Systemic reaction (other): Recuperating from surgery on April 14, 2021

Release 8 — days 1–6 daily, dose 2

2021-04-29

Systemic reaction (other): Post-Op Hernia Repair (April 14, 2021)

2021-04-30

Systemic reaction (other): Body temperature back to normal as of this morning.

2021-05-01

Systemic reaction (other): Recuperating from April 14 surgery.

2021-05-02

Systemic reaction (other): Slowly regaining more physical movement after surgery.

2021-05-03

Systemic reaction (other): Working on becoming more physically active after April 14 surgery.

2021-05-04

Systemic reaction (other): I increased my physical activity today.

Release 8 — day 7, dose 2

2021-05-05

Systemic reaction (other): Regaining more strength with more movement after April 14, 2021 operation.

Release 9 — 3 months, dose 2

2021-07-28

Symptoms: On Friday, July 23, 2021 I was sent home due to heat exhaustion. Today my primary care physician cleared me to return to work tomorrow, Thursday July 29. Infection was ruled out through blood work and physical examination. Life stress a factor.

Release 11 — 6 months, dose 3

2022-05-06

Symptoms: Tiredness

Healthcare visit (other): Primary Health Care Provider Clinic

Release 11 — day 0, dose 4

2022-05-27

Systemic reaction (other): I've been diagnosed with psychological burn out. Since May 03, 2022 I have been on medical leave from work. My return to work date is yet to determined..

Healthcare visit (other): An in home visit from a social worker with the local county human services department.

Release 11 — days 1–6 daily, dose 4

2022-05-31

Systemic reaction (other): On medical leave diagnosed with psychological burn out.

Healthcare visit (other): Clinic of Primary Care Provider

Release 12 — day 28, dose 4

2022-06-24

Symptoms: PTSD. I consider this condition unrelated to the COVID vaccination. I have been seeing a therapist and physician for the PTSD.

Release 12 — day 35, dose 5

2022-12-28

Symptoms: This last week I had my annual eye exam. My cataracts have slightly progressed. The very beginning of macular degeneration has been newly diagnosed for me.

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	Home care	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Surgery	✓	✓	✓
SD	Cataract	·	·	✓
SD	Fatigue	·	·	✓
SD	Heat exhaustion	✓	·	✓
SD	Hernia repair	✓	·	✓
SD	Impaired work ability	✓	·	✓
SD	Laparoscopic surgery	✓	✓	✓
SD	Macular degeneration	·	·	✓
SD	Office visit	✓	·	✓
SD	Post-traumatic stress disorder	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Stress	✓	·	✓
SD	Unevaluable event	○	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Body temperature abnormal	✓	✓	✓
SRO	Burnout syndrome	·	·	✓
SRO	Hernia	✓	✓	✓
SRO	Hernia repair	✓	✓	✓
SRO	Sick leave	·	·	✓
SRO	Surgery	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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