3PA-14087-05020

3 vaccinations 13 coded responses 39 check-ins 13 free-text entries 2 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 791 / TX
Registered: 2020-12-28

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

2020-12-28
Registered in v-safe
2020-12-28
Dose 1 — Moderna
2020-12-28
Survey response — day 0, dose 1
MedDRA: Arthralgia, Nausea, Pain — Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting

Free text: I always have aches and joint pain. I was feeling nauseous yesterday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-29
Survey response — days 1–6 daily, dose 1
MedDRA: Myalgia, Office visit, Pain, Paraesthesia oral, Pre-existing disease — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Saw my doctor. He thinks that I may have had a stomach virus and or reaction to the vaccine. Some of the symptoms that I have or have had such as pain and muscle aches are normal. I'm in pain all the time. Also have sinus and allergies that aggravate me. My doctor said that my lungs sound clear and I don't have any abnormal symptoms except my tongue and mouth are tingling for lack of a better term. · Healthcare visit (other): A visit with my PCP

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-29
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2020-12-30
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Myalgia, Office visit, Pre-existing disease — Feeling: Fair · 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, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): I have chronic pain so I don't think that the muscle aches and joints are due to shots · Healthcare visit (other): PCP yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-30
Report sent to call center — days 1–6 daily, 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)
2020-12-31
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-01
Survey response — days 1–6 daily, dose 1
MedDRA: Paraesthesia oral — Feeling: Good · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: I have had a tingling in my mouth an tongue since the vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-02
Survey response — days 1–6 daily, dose 1
MedDRA: Adverse reaction — Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: These are normal symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-03
Survey response — days 1–6 daily, dose 1
MedDRA: Pain — Feeling: Good · Joint pains, Muscle or body aches

Free text: Chronic pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-04
Survey response — day 7, dose 1
MedDRA: Pre-existing disease — Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Have chronic pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-18
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-18
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-01-25
Dose 2 — Moderna
2021-01-25
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-22
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-01
Survey response — day 35, dose 2
MedDRA: Upper respiratory tract infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: I believe that I have a URI

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — day 42, dose 2
MedDRA: Asthma, Condition aggravated, Pre-existing disease — Feeling: Good

Free text: Asthma and sinus trouble worsened

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-26
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-28
Dose 3 — Moderna
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Eye disorder, Headache, Oropharyngeal pain — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Sore throat, headache and a temporary eye problem

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Photopsia — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Had lights in each eyes for about 30 minutes

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-04
Health check-in — day 7, dose 3
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

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

Adult check-in
2021-11-18
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-25
Survey response — day 28, dose 3
MedDRA: Gastroenteritis viral, Hypersomnia, Malaise, Pyrexia, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Stomach flu, throwing up, took temperature once and it was 102. Lasted a little over 24 hours. Slept the night before, all day and all the next night. Very sick.

MedDRA releases: 2024-11 · check-in free text available
2021-12-02
Survey response — day 35, dose 3
MedDRA: Blood glucose increased, Influenza, Pain, Pyrexia, Somnolence, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Flu I guess. Ran fever and threw up. Could not stay awake. Bad body aches. High glucose levels.

MedDRA releases: 2024-11 · check-in free text available
2021-12-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-27
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-28
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-28	Moderna
2	2021-01-25	Moderna
3	2021-10-28	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 1 — day 0, dose 1

2020-12-28

Systemic reaction (other): I always have aches and joint pain. I was feeling nauseous yesterday.

Release 1 — days 1–6 daily, dose 1

2020-12-29

Systemic reaction (other): Saw my doctor. He thinks that I may have had a stomach virus and or reaction to the vaccine. Some of the symptoms that I have or have had such as pain and muscle aches are normal. I'm in pain all the time. Also have sinus and allergies that aggravate me. My doctor said that my lungs sound clear and I don't have any abnormal symptoms except my tongue and mouth are tingling for lack of a better term.

Healthcare visit (other): A visit with my PCP

2020-12-30

Systemic reaction (other): I have chronic pain so I don't think that the muscle aches and joints are due to shots

Healthcare visit (other): PCP yesterday

2021-01-01

Systemic reaction (other): I have had a tingling in my mouth an tongue since the vaccine

2021-01-02

Systemic reaction (other): These are normal symptoms

2021-01-03

Systemic reaction (other): Chronic pain

Release 1 — day 7, dose 1

2021-01-04

Systemic reaction (other): Have chronic pain

Release 4 — day 35, dose 2

2021-03-01

Symptoms: I believe that I have a URI

Release 5 — day 42, dose 2

2021-03-08

Symptoms: Asthma and sinus trouble worsened

Release 10 — days 1–6 daily, dose 3

2021-10-30

Systemic reaction (other): Sore throat, headache and a temporary eye problem

2021-10-31

Systemic reaction (other): Had lights in each eyes for about 30 minutes

Release 10 — day 28, dose 3

2021-11-25

Symptoms: Stomach flu, throwing up, took temperature once and it was 102. Lasted a little over 24 hours. Slept the night before, all day and all the next night. Very sick.

Release 10 — day 35, dose 3

2021-12-02

Symptoms: Flu I guess. Ran fever and threw up. Could not stay awake. Bad body aches. High glucose levels.

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	Medical observation	○	○	○
HCVO	Office visit	✓	✓	✓
SD	Asthma	✓	✓	✓
SD	Blood glucose increased	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Gastroenteritis viral	·	·	✓
SD	Hypersomnia	·	·	✓
SD	Influenza	·	·	✓
SD	Malaise	·	·	✓
SD	Pain	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	Somnolence	·	·	✓
SD	Upper respiratory tract infection	✓	✓	✓
SD	Vomiting	·	·	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Eye disorder	·	·	✓
SRO	Headache	·	·	✓
SRO	Myalgia	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Nonspecific reaction	○	○	○
SRO	Oropharyngeal pain	·	·	✓
SRO	Pain	✓	✓	✓
SRO	Paraesthesia oral	✓	✓	✓
SRO	Photopsia	·	·	✓
SRO	Pre-existing disease	✓	✓	✓

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