3X2-14133-19921

4 vaccinations 9 coded responses 43 check-ins 8 free-text entries 0 call cases

Sex: Male
Age at first dose: 46-50
ZIP prefix: 770 / TX
Registered: 2021-03-04

Relationship: Self
Race: Asian
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

2021-03-04
Registered in v-safe
2021-03-04
Dose 1 — Janssen/Johnson & Johnson
2021-03-04
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-05
Survey response — days 1–6 daily, dose 1
MedDRA: Abnormal dreams, Insomnia — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Neuropsych - strange dreams - sleep difficulty (I normally never have sleep issues, even with fever)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-25
Survey response — day 21, single dose
MedDRA: Malaise — Feeling: Fair

Free text: Disproportional Malaise, Vague feeling of about to get sick, has been occurring for past 2 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — day 28, single dose
MedDRA: Urticaria — Feeling: Good

Free text: Mild urticaria - unclear etiology

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 35, single dose
Feeling: Good

Adult check-in
2021-04-15
Health check-in — day 42, single dose
Feeling: Good

Adult check-in
2021-06-03
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-09-08
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2021-09-13
Dose 2 — Moderna
2021-09-15
Survey response — days 1–6 daily, dose 2
MedDRA: Temporomandibular joint syndrome — Feeling: Fair · Fever · Chills, Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: TMJ arthralgia

MedDRA releases: 2024-11 · check-in free text available
2021-09-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-09-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-09-21
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-09-27
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-10-04
Survey response — day 21, dose 2
MedDRA: Fatigue — Feeling: Fair

Free text: Generalized fatigue

MedDRA releases: 2024-11 · check-in free text available
2021-10-13
Survey response — day 28, dose 2
MedDRA: Headache — Feeling: Good

Free text: Headache

MedDRA releases: 2024-11 · check-in free text available
2021-10-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-10-27
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-12-13
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-03-16
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-05-15
Dose 3 — Pfizer-BioNTech
2022-05-16
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2022-05-17
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · Fatigue or tiredness

Adult check-in
2022-05-18
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-05-19
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-05-20
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-05-21
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-05-24
Survey response — day 7, dose 3
MedDRA: Pre-existing disease, Urticaria — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Mild reactivation of urticaria specifically in area of Lyme-confirmed tick bites that occurred two years ago

MedDRA releases: 2024-11 · check-in free text available
2022-06-05
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-06-12
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-08-16
Survey response — 3 months, dose 3
MedDRA: Exposure to SARS-CoV-2, Fatigue, Pyrexia, Respiratory symptom, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: 1. At end of June I was in France on river cruise and experienced 36-48 hrs of fever & fatigue with no other symptoms. Others on boat were COVID positive with similar symptoms. At end July had 2 days fever, 10 days URI sx, COVID test negative x 2

MedDRA releases: 2024-11 · check-in free text available
2022-10-23
Dose 4 — Moderna
2022-11-15
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-15
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-20
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-27
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-04
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-01-22
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-04-25
Survey response — 6 months, dose 4
MedDRA: Lower respiratory tract congestion, Productive cough, Respiratory symptom — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-04	Janssen/Johnson & Johnson
2	2021-09-13	Moderna	No
3	2022-05-15	Pfizer-BioNTech	No
4	2022-10-23	Moderna	No

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-05

Systemic reaction (other): Neuropsych - strange dreams - sleep difficulty (I normally never have sleep issues, even with fever)

Release 6 — day 21, single dose

2021-03-25

Symptoms: Disproportional Malaise, Vague feeling of about to get sick, has been occurring for past 2 days

Release 6 — day 28, single dose

2021-04-03

Symptoms: Mild urticaria - unclear etiology

Release 9 — days 1–6 daily, dose 2

2021-09-15

Systemic reaction (other): TMJ arthralgia

Release 9 — day 21, dose 2

2021-10-04

Symptoms: Generalized fatigue

Release 10 — day 28, dose 2

2021-10-13

Symptoms: Headache

Release 11 — day 7, dose 3

2022-05-24

Systemic reaction (other): Mild reactivation of urticaria specifically in area of Lyme-confirmed tick bites that occurred two years ago

Release 12 — 3 months, dose 3

2022-08-16

Symptoms: 1. At end of June I was in France on river cruise and experienced 36-48 hrs of fever & fatigue with no other symptoms. Others on boat were COVID positive with similar symptoms. At end July had 2 days fever, 10 days URI sx, COVID test negative x 2

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	Exposure to SARS-CoV-2	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Lower respiratory tract congestion	·	·	✓
SD	Malaise	✓	✓	✓
SD	Productive cough	·	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory symptom	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Urticaria	✓	✓	✓
SRO	Abnormal dreams	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Pre-existing disease	·	·	✓
SRO	Temporomandibular joint syndrome	·	·	✓
SRO	Urticaria	·	·	✓

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