3TY-48387-02979

3 vaccinations 12 coded responses 22 check-ins 12 free-text entries 0 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 122 / NY
Registered: 2021-03-14

Relationship: Self
Race: Multiracial
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

2021-03-08
Dose 1 — Moderna
2021-03-14
Registered in v-safe
2021-03-14
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Good

Free text: I have comorbidities of diabeties, high blood pressure, and afibrillation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-05
Dose 2 — Moderna
2021-04-05
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Injection site pain, Myalgia — Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Pain at injection sight And pain in right hip and right side quadraceps

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Gait disturbance, Pain, Pain in extremity — Feeling: Good · Site: Pain

Free text: I could barely walk yesterday due to pain in my hip radiating down to my thigh. Today I can walk with no pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-09
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Mo

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Survey response — day 7, dose 2
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-03
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-10
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-17
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-07
Survey response — 3 months, dose 2
MedDRA: Arthralgia — Feeling: Good

Free text: It seems my joints are more painful

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-04
Survey response — 6 months, dose 2
MedDRA: Dizziness, Fatigue, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities

Free text: Dizzyness, fatigue, imbalance

MedDRA releases: 2024-11 · check-in free text available
2021-10-23
Dose 3 — Moderna
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue, Headache, Myalgia, Presyncope, Pyrexia — Feeling: Good · Muscle or body aches

Free text: The day after the booster shot I had a bad headache, Fatigue, fever, muscle ache and nearly fainted.

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-06
Survey response — day 14, dose 3
MedDRA: Blood glucose increased, Hypertension — Feeling: Fair

Free text: High blood pressure High blood Glucose

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-08	Moderna
2	2021-04-05	Moderna
3	2021-10-23	Moderna	No

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-14

Systemic reaction (other): I have comorbidities of diabeties, high blood pressure, and afibrillation

Release 6 — day 0, dose 2

2021-04-05

Systemic reaction (other): No

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): Pain at injection sight And pain in right hip and right side quadraceps

2021-04-07

Systemic reaction (other): I could barely walk yesterday due to pain in my hip radiating down to my thigh. Today I can walk with no pain.

2021-04-09

Systemic reaction (other): Mo

2021-04-10

Systemic reaction (other): No

2021-04-11

Systemic reaction (other): No

Release 7 — day 7, dose 2

2021-04-12

Systemic reaction (other): No

Release 9 — 3 months, dose 2

2021-07-07

Symptoms: It seems my joints are more painful

Release 10 — 6 months, dose 2

2021-10-04

Symptoms: Dizzyness, fatigue, imbalance

Release 10 — days 1–6 daily, dose 3

2021-10-29

Systemic reaction (other): The day after the booster shot I had a bad headache, Fatigue, fever, muscle ache and nearly fainted.

Release 10 — day 14, dose 3

2021-11-06

Symptoms: High blood pressure High blood Glucose

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	Arthralgia	✓	✓	✓
SD	Blood glucose increased	·	·	✓
SD	Dizziness	·	·	✓
SD	Fatigue	·	·	✓
SD	Hypertension	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Fatigue	·	·	✓
SRO	Gait disturbance	✓	✓	✓
SRO	Headache	·	·	✓
SRO	Injection site pain	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Presyncope	·	·	✓
SRO	Pyrexia	·	·	✓

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