3U8-18770-25977

3 vaccinations 10 coded responses 36 check-ins 10 free-text entries 0 call cases

Sex: Male
Age at first dose: 31-35
ZIP prefix: 704 / LA
Registered: 2021-03-13

Relationship: Self
Race: White
Ethnicity: 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

2021-03-12
Dose 1 — Moderna
2021-03-13
Registered in v-safe
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None · Be unable to do your normal daily activities

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-09
Dose 2 — Moderna
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-11
Survey response — days 1–6 daily, dose 2
MedDRA: Tremor — Feeling: Poor · Site: Pain · Fever · 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: Shaking

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Survey response — days 1–6 daily, dose 2
MedDRA: Dry skin, Lymph node pain, Lymphadenopathy, Pruritus, Sensitive skin — Feeling: Poor · Site: Pain · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Very Dry Itchy Skin and Scalp, Sensitive Skin To Touch,Left And Right Arm Pits Lymph Node Swollen/Tenderness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain, Epistaxis, Lymph node pain, Lymphadenopathy, Nasal dryness, Pruritus — Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Diaphragm Pain-Moderate,Tender/Swollen Armpit Glads-moderate pain, Itchy Scalp, Dry Nasal Passages/Mild Bloody Nose.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — days 1–6 daily, dose 2
MedDRA: Dry skin, Pain, Pruritus, Skin disorder — Feeling: Fair · Site: Pain · Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Dry, Ichy, Sensitive Scalp. Now having issues with dandruff. Never had this B4. Diaphragm Pain-Moderate. All other extra reported symptoms have subsided.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-16
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-23
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-30
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-09
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-11-02
Dose 3 — Moderna
2021-11-02
Survey response — day 0, dose 3
MedDRA: Cough — Feeling: Poor · Site: Pain · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Caughing Attacks

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — 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: Caughing Attacks

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

Free text: Caughing Attacks

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness

Free text: Mild Cough

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness

Free text: Slight Cough

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-09
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-16
Survey response — day 14, dose 3
MedDRA: Arthralgia, Injection site pain — Feeling: Good · Be unable to do your normal daily activities

Free text: Shoulder and Injection Site Pain.

MedDRA releases: 2024-11 · check-in free text available
2021-11-23
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-02
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-14
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-03
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-11-02
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-12	Moderna
2	2021-04-09	Moderna
3	2021-11-02	Moderna	No

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-11

Systemic reaction (other): Shaking

2021-04-12

Systemic reaction (other): Very Dry Itchy Skin and Scalp, Sensitive Skin To Touch,Left And Right Arm Pits Lymph Node Swollen/Tenderness

2021-04-13

Systemic reaction (other): Diaphragm Pain-Moderate,Tender/Swollen Armpit Glads-moderate pain, Itchy Scalp, Dry Nasal Passages/Mild Bloody Nose.

2021-04-14

Systemic reaction (other): Dry, Ichy, Sensitive Scalp. Now having issues with dandruff. Never had this B4. Diaphragm Pain-Moderate. All other extra reported symptoms have subsided.

Release 10 — day 0, dose 3

2021-11-02

Systemic reaction (other): Caughing Attacks

Release 10 — days 1–6 daily, dose 3

2021-11-03

Systemic reaction (other): Caughing Attacks

2021-11-04

Systemic reaction (other): Caughing Attacks

2021-11-06

Systemic reaction (other): Mild Cough

2021-11-07

Systemic reaction (other): Slight Cough

Release 10 — day 14, dose 3

2021-11-16

Symptoms: Shoulder and Injection Site Pain.

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	Injection site pain	·	·	✓
SRO	Chest pain	✓	✓	✓
SRO	Cough	·	·	✓
SRO	Dry skin	✓	✓	✓
SRO	Epistaxis	✓	✓	✓
SRO	Lymph node pain	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Nasal dryness	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Sensitive skin	✓	✓	✓
SRO	Skin disorder	✓	✓	✓
SRO	Tremor	✓	✓	✓

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