3R8-26426-66934

3 vaccinations 11 coded responses 39 check-ins 11 free-text entries 0 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 310 / GA
Registered: 2021-01-25

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-01-25
Registered in v-safe
2021-01-25
Dose 1 — Moderna
2021-01-25
Survey response — day 0, dose 1
MedDRA: Unevaluable event — Feeling: Fair

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good

Free text: Just shot area a little sore

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-01-29
Survey response — days 1–6 daily, dose 1
MedDRA: SARS-CoV-2 test positive — Feeling: Fair · Site: Pain · Fever · Chills, Fatigue or tiredness

Free text: I tested positive today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Survey response — days 1–6 daily, dose 1
MedDRA: COVID-19 — Feeling: Fair · Chills, Muscle or body aches

Free text: I got checked positive 4 days after my shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Survey response — day 7, dose 1
MedDRA: COVID-19 — Feeling: Fair · Chills, Headache, Fatigue or tiredness

Free text: I have covid

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-02-15
Survey response — day 21, dose 1
MedDRA: Hypertension — Feeling: Good

Free text: Higher Blood pressures.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-01
Dose 2 — Moderna
2021-03-01
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Pharyngeal swelling, Pruritus, Swelling — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Swelling, itching, throat swelling.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Swelling, Itching · Fever · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Diarrhea

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-08
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-12
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-31
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-30
Survey response — 6 months, dose 2
MedDRA: Bowel movement irregularity, Haematochezia — Feeling: Good

Free text: I had occult blood in my stool and changes in BMs. They are doing tests. Probably nothing to do with Covid.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-12-13
Dose 3 — Moderna
2021-12-14
Survey response — days 1–6 daily, dose 3
MedDRA: Pruritus, Urticaria — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Hives, itching...had it after second and now this third shot.

MedDRA releases: 2024-11 · check-in free text available
2021-12-15
Survey response — days 1–6 daily, dose 3
MedDRA: Pruritus — Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Itchy areas....getting fewer

MedDRA releases: 2024-11 · check-in free text available
2021-12-16
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness, Itching · Rash, not including the immediate area around the injection site

Adult check-in
2021-12-17
Survey response — days 1–6 daily, dose 3
MedDRA: Allergy to vaccine, Erythema, Fatigue, Pruritus, Rash, Swelling, Throat tightness — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Each Moderna shot gets progressively worse symptoms concerning rash, itching, redness, tiredness and swelling...now with some throat closure. I am/have become allergic to Moderna vaccine it appears.

MedDRA releases: 2024-11 · check-in free text available
2021-12-18
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-20
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-27
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-01-03
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-10
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-17
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-24
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-14
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-13
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-12-15
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-25	Moderna
2	2021-03-01	Moderna
3	2021-12-13	Moderna	No

Free text

Release 2 — day 0, dose 1

2021-01-25

Systemic reaction (other): No

Release 2 — days 1–6 daily, dose 1

2021-01-26

Systemic reaction (other): Just shot area a little sore

Release 3 — days 1–6 daily, dose 1

2021-01-29

Systemic reaction (other): I tested positive today

2021-01-31

Systemic reaction (other): I got checked positive 4 days after my shot

Release 3 — day 7, dose 1

2021-02-01

Systemic reaction (other): I have covid

Release 4 — day 21, dose 1

2021-02-15

Symptoms: Higher Blood pressures.

Release 4 — days 1–6 daily, dose 2

2021-03-02

Systemic reaction (other): Swelling, itching, throat swelling.

Release 9 — 6 months, dose 2

2021-08-30

Symptoms: I had occult blood in my stool and changes in BMs. They are doing tests. Probably nothing to do with Covid.

Release 10 — days 1–6 daily, dose 3

2021-12-14

Systemic reaction (other): Hives, itching...had it after second and now this third shot.

2021-12-15

Systemic reaction (other): Itchy areas....getting fewer

2021-12-17

Systemic reaction (other): Each Moderna shot gets progressively worse symptoms concerning rash, itching, redness, tiredness and swelling...now with some throat closure. I am/have become allergic to Moderna vaccine it appears.

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	Bowel movement irregularity	✓	·	✓
SD	Haematochezia	✓	·	✓
SD	Hypertension	✓	✓	✓
SRO	Allergy to vaccine	·	·	✓
SRO	COVID-19	✓	✓	✓
SRO	Erythema	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Injection site pain	✓	✓	✓
SRO	Pharyngeal swelling	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	·	·	✓
SRO	SARS-CoV-2 test positive	✓	✓	✓
SRO	Swelling	✓	✓	✓
SRO	Throat tightness	·	·	✓
SRO	Unevaluable event	✓	✓	✓
SRO	Urticaria	·	·	✓

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