3PY-22621-17610

2 vaccinations 9 coded responses 16 check-ins 9 free-text entries 1 call case

Sex: Male
Age at first dose: 56-60
ZIP prefix: 070 / NJ
Registered: 2021-04-29

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-27
Dose 1 — Moderna
2021-04-29
Registered in v-safe
2021-04-29
Survey response — days 1–6 daily, dose 1
MedDRA: Hypoaesthesia, Paraesthesia — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Left hand: numbness and tingling sensation.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good · Headache, Nausea

Free text: None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness

Free text: None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Health check-in — day 7, dose 1
Feeling: Fair · Chills, Headache, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-05-12
Survey response — day 14, dose 1
MedDRA: Dyspnoea, Headache, Hypoaesthesia, Pain, Paraesthesia, Swelling — Feeling: Fair · Be unable to work

Free text: Not new or worsening. Just that my headaches have been an 8, on a scale of 1-10. My body aches have been a high level of pain. Lower back, feet, and shoulders. Numbness in hands, and arm, with a tingling sensation. Some swelling. Shortness of breath.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-05-25
Dose 2 — Moderna
2021-05-25
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain · Headache · Be unable to work, Be unable to do your normal daily activities

Free text: None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-06-01
Survey response — day 7, dose 2
MedDRA: Dyspnoea — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Shortness of breath.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-08
Survey response — day 14, dose 2
MedDRA: Pain, Rash — Feeling: Fair · Be unable to work

Free text: A rash on my left ankle. Still having body aches. 06/04/21

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-18
Survey response — day 21, dose 2
MedDRA: Abdominal discomfort, Nausea, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: My stomach has been upset for about three days. Nausea, and vomiting on the first day. Every day after, just constant nausea.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-29
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-07-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-11-25
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-05-27
Survey response — 12 months, dose 2
MedDRA: Rash — 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, Emergency room or emergency department visit

Free text: I am now breaking out with bumps and a rash all over my body. VA doctor has prescribed Certirizine, Diphenhydramine, Methylprednisolone, and topical (Eucirin) every day for nine(9)months. Two and a half (2 1/2)months after shots.

MedDRA releases: 2024-11 · check-in free text available
2022-05-27
Report sent to call center — 12 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

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-05-31
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-27	Moderna
2	2021-05-25	Moderna

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 8 — days 1–6 daily, dose 1

2021-04-29

Systemic reaction (other): Left hand: numbness and tingling sensation.

2021-04-30

Systemic reaction (other): None

2021-05-02

Systemic reaction (other): None

Release 8 — day 14, dose 1

2021-05-12

Symptoms: Not new or worsening. Just that my headaches have been an 8, on a scale of 1-10. My body aches have been a high level of pain. Lower back, feet, and shoulders. Numbness in hands, and arm, with a tingling sensation. Some swelling. Shortness of breath. cut off by CDC

Release 8 — day 0, dose 2

2021-05-25

Systemic reaction (other): None

Release 8 — day 7, dose 2

2021-06-01

Systemic reaction (other): Shortness of breath.

Release 8 — day 14, dose 2

2021-06-08

Symptoms: A rash on my left ankle. Still having body aches. 06/04/21

Release 9 — day 21, dose 2

2021-06-18

Symptoms: My stomach has been upset for about three days. Nausea, and vomiting on the first day. Every day after, just constant nausea.

Release 11 — 12 months, dose 2

2022-05-27

Symptoms: I am now breaking out with bumps and a rash all over my body. VA doctor has prescribed Certirizine, Diphenhydramine, Methylprednisolone, and topical (Eucirin) every day for nine(9)months. Two and a half (2 1/2)months after shots.

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 discomfort	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Paraesthesia	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Swelling	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓

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