3S3-31119-33286

3 vaccinations 10 coded responses 34 check-ins 10 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 600 / IL
Registered: 2021-02-04

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

2021-02-04
Registered in v-safe
2021-02-09
Dose 1 — Moderna
2021-02-09
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · None

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Somnolence — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Tired. Sleepy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Fatigue or tiredness

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-14
Survey response — days 1–6 daily, dose 1
MedDRA: Respiratory tract congestion — Feeling: Fair · Fatigue or tiredness

Free text: Upper chest congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-02
Survey response — day 21, dose 1
MedDRA: Fatigue, Pain in extremity, Peripheral swelling — Feeling: Fair

Free text: 14 days after shot arm swelling with some pain and the swelling moved to my bicep. Felt tired for the week it took to go down

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-03-18
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-03-24
Dose 2 — Moderna
2021-03-24
Health check-in — day 0, dose 2
Feeling: Fair · Chills, Fatigue or tiredness

Adult check-in
2021-03-25
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: No appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-03-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-02
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-14
Survey response — day 21, dose 2
MedDRA: Abdominal pain upper, Faecaloma, Hospitalisation, Pancreatitis — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Stomach pain..inflamed pancreas...hospitalized fecal impact

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Survey response — day 28, dose 2
MedDRA: Pancreatitis — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Pancreatitis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-24
Survey response — 3 months, dose 2
MedDRA: Muscle spasms — Feeling: Fair

Free text: Muscle spasm in the arm where the second shot was given and it has not gone away

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-22
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-03
Dose 3 — Moderna
2021-11-03
Survey response — day 0, dose 3
MedDRA: Influenza — Feeling: Fair · Fatigue or tiredness

Free text: Flu symptons

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

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

Adult check-in
2021-12-01
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-08
Survey response — day 35, dose 3
MedDRA: Dysuria, Office visit, Prostatomegaly, Urine flow decreased — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Prostrate enlarged. Weak or painful urination. Is it related to vaccine I don't know for my age it is probably age related. · Healthcare visit (other): Contacted doctor.Office visit

MedDRA releases: 2024-11 · check-in free text available
2021-12-08
Report sent to call center — day 35, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-13
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-15
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-02-02
Survey response — 3 months, dose 3
MedDRA: Pain, Proctitis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Bad case of proctatitis which lasted for 4 to 6 weeks still recovering could not get hospitilazion because of pandemic so i suffered with incrediable pain for weeks

MedDRA releases: 2024-11 · check-in free text available
2022-02-02
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-02-04
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-05-04
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Moderna
2	2021-03-24	Moderna
3	2021-11-03	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Tired. Sleepy

2021-02-14

Systemic reaction (other): Upper chest congestion

Release 4 — day 21, dose 1

2021-03-02

Symptoms: 14 days after shot arm swelling with some pain and the swelling moved to my bicep. Felt tired for the week it took to go down

Release 6 — days 1–6 daily, dose 2

2021-03-25

Systemic reaction (other): No appetite

Release 7 — day 21, dose 2

2021-04-14

Symptoms: Stomach pain..inflamed pancreas...hospitalized fecal impact

Release 7 — day 28, dose 2

2021-04-21

Symptoms: Pancreatitis

Release 9 — 3 months, dose 2

2021-06-24

Symptoms: Muscle spasm in the arm where the second shot was given and it has not gone away

Release 10 — day 0, dose 3

2021-11-03

Systemic reaction (other): Flu symptons

Release 10 — day 35, dose 3

2021-12-08

Symptoms: Prostrate enlarged. Weak or painful urination. Is it related to vaccine I don't know for my age it is probably age related.

Healthcare visit (other): Contacted doctor.Office visit

Release 11 — 3 months, dose 3

2022-02-02

Symptoms: Bad case of proctatitis which lasted for 4 to 6 weeks still recovering could not get hospitilazion because of pandemic so i suffered with incrediable pain for weeks

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	Office visit	·	·	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Dysuria	·	·	✓
SD	Faecaloma	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Muscle spasms	✓	✓	✓
SD	Pain	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Pancreatitis	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Proctitis	·	·	✓
SD	Prostatomegaly	·	·	✓
SD	Urine flow decreased	·	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Influenza	·	·	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Somnolence	✓	✓	✓

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