3M2-67129-80964

3 vaccinations 10 coded responses 26 check-ins 9 free-text entries 1 call case

Sex: Male
Age at first dose: 51-55
ZIP prefix: 992 / WA
Registered: 2021-02-12

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

2021-02-04
Dose 1 — Moderna
2021-02-12
Registered in v-safe
2021-02-12
Survey response — day 7, dose 1
MedDRA: Abdominal discomfort — Feeling: Good · Site: Pain

Free text: upset stomach for about a week after the shot - it stopped today 2-12-21

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-04
Dose 2 — Moderna
2021-03-04
Survey response — day 0, dose 2
MedDRA: Adverse reaction — Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Symptoms have been mild.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Dizziness or vertigo

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Itching · Muscle or body aches, Fatigue or tiredness, Nausea

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

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 — day 7, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-03-18
Survey response — day 14, dose 2
MedDRA: Nausea, Pain, Pyrexia — Feeling: Good

Free text: On the 17th I was achy, feverish and nauseous, mildly. It was uncomfortable but went away.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Survey response — day 21, dose 2
MedDRA: Fatigue, Influenza, Malaise, Musculoskeletal stiffness, Nervousness — Feeling: Fair · Be unable to work

Free text: Today I am home from work due to feeling shaky and a bit flu-ish. Very tired also. No fever. Some stiffness and my body just feels crummy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-08
Survey response — day 35, dose 2
MedDRA: Abdominal pain, Nausea, Pain, Pre-existing disease — Feeling: Fair

Free text: Near the site of a hernia I had repaired, just above my belly button it has gotten painful now and then. A sharp stinging pain depending on what I am doing. And I have been sick to my stomach today, off and on. I am 265 pounds. 100 lbs overweight

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-03
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-02
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-10
Dose 3 — Moderna
2022-03-04
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-03-04
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-03-10
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-03-17
Survey response — day 35, dose 3
MedDRA: Fatigue, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities

Free text: I didn't think it was related before. Over many months I have been constantly very fatigued during the day. Almost like being drugged heavily. It may be my diabetes or something else. I am seeing my doctor for a physical soon and will tell him.

MedDRA releases: 2024-11 · check-in free text available
2022-03-24
Survey response — day 42, dose 3
MedDRA: Dyspnoea — Feeling: Fair · Be unable to work or attend school

Free text: Shortness of breath intermittently

MedDRA releases: 2024-11 · check-in free text available
2022-05-12
Survey response — 3 months, dose 3
MedDRA: Dyspnoea — Feeling: Good

Free text: Shortness of breath randomly.

MedDRA releases: 2024-11 · check-in free text available
2022-08-11
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2023-02-10
Survey response — 12 months, dose 3
MedDRA: Colitis, Dehydration, Emergency care, Hospitalisation, Nasopharyngitis — 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 · Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11
2023-02-10
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)
2023-02-13
Call successful
Not applicable - Accidental Reporting

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna
2	2021-03-04	Moderna
3	2022-02-10	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 4 — day 7, dose 1

2021-02-12

Systemic reaction (other): upset stomach for about a week after the shot - it stopped today 2-12-21

Release 5 — day 0, dose 2

2021-03-04

Systemic reaction (other): Symptoms have been mild.

Release 5 — days 1–6 daily, dose 2

2021-03-05

Systemic reaction (other): Dizziness or vertigo

Release 5 — day 14, dose 2

2021-03-18

Symptoms: On the 17th I was achy, feverish and nauseous, mildly. It was uncomfortable but went away.

Release 6 — day 21, dose 2

2021-03-25

Symptoms: Today I am home from work due to feeling shaky and a bit flu-ish. Very tired also. No fever. Some stiffness and my body just feels crummy.

Release 7 — day 35, dose 2

2021-04-08

Symptoms: Near the site of a hernia I had repaired, just above my belly button it has gotten painful now and then. A sharp stinging pain depending on what I am doing. And I have been sick to my stomach today, off and on. I am 265 pounds. 100 lbs overweight cut off by CDC

Release 11 — day 35, dose 3

2022-03-17

Symptoms: I didn't think it was related before. Over many months I have been constantly very fatigued during the day. Almost like being drugged heavily. It may be my diabetes or something else. I am seeing my doctor for a physical soon and will tell him. cut off by CDC

Release 11 — day 42, dose 3

2022-03-24

Symptoms: Shortness of breath intermittently

Release 11 — 3 months, dose 3

2022-05-12

Symptoms: Shortness of breath randomly.

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	Abdominal pain	✓	✓	✓
SD	Colitis	·	·	✓
SD	Dehydration	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Emergency care	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Hospitalisation	·	·	✓
SD	Influenza	✓	✓	✓
SD	Malaise	✓	✓	✓
SD	Musculoskeletal stiffness	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Nausea	✓	✓	✓
SD	Nervousness	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Dizziness	✓	✓	✓

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