46Z-52701-18876

2 vaccinations 11 coded responses 22 check-ins 11 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 770 / TX
Registered: 2021-02-10

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

2021-02-10
Registered in v-safe
2021-02-10
Dose 1 — Moderna
2021-02-10
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Good · Chills, Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 1
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
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — day 14, dose 1
Feeling: Good

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

Adult check-in
2021-03-10
Survey response — day 28, dose 1
MedDRA: Cough, Fatigue, Feeling abnormal, Rhinorrhoea, Sneezing — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: I havent felt good for the last two days and, therefore, had to reschedule my 2nd shot to 03/29/2021. No fever, just tired, runny nose, sneezing and a cough.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — day 35, dose 1
MedDRA: Hypersensitivity, Influenza like illness, Rhinorrhoea, Sneezing — Feeling: Fair

Free text: I have allergy/flu like symptoms. No fever, some nasal drip, an occasional sneeze, no cough.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Dose 2 — Moderna
2021-03-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-25
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good

Free text: None.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — days 1–6 daily, dose 2
MedDRA: Cough — Feeling: Good

Free text: A kind of dry cough today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Respiratory tract congestion, Sneezing — Feeling: Fair

Free text: Have cough, some sneezing and chest congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — day 7, dose 2
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: No other symptoms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-13
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-20
Survey response — day 28, dose 2
MedDRA: Headache, Rhinorrhoea — Feeling: Fair

Free text: I have a runny nose, sniffling, slight head ache.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-04
Survey response — day 42, dose 2
MedDRA: Eye infection, Fatigue — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Im tired more than usual. I also have had an eye infection for over four weeks.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-24
Survey response — 3 months, dose 2
MedDRA: Eye allergy — Feeling: Fair · Be unable to do your normal daily activities

Free text: Allergy in my eyes.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-21
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-03-23
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-04-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-10	Moderna
2	2021-03-23	Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 4 — day 0, dose 1

2021-02-10

Systemic reaction (other): No

Release 4 — days 1–6 daily, dose 1

2021-02-11

Systemic reaction (other): No

Release 5 — day 28, dose 1

2021-03-10

Symptoms: I havent felt good for the last two days and, therefore, had to reschedule my 2nd shot to 03/29/2021. No fever, just tired, runny nose, sneezing and a cough.

Release 5 — day 35, dose 1

2021-03-17

Symptoms: I have allergy/flu like symptoms. No fever, some nasal drip, an occasional sneeze, no cough.

Release 6 — days 1–6 daily, dose 2

2021-03-25

Systemic reaction (other): None.

2021-03-26

Systemic reaction (other): A kind of dry cough today.

2021-03-27

Systemic reaction (other): Have cough, some sneezing and chest congestion

Release 6 — day 7, dose 2

2021-03-30

Systemic reaction (other): No other symptoms.

Release 7 — day 28, dose 2

2021-04-20

Symptoms: I have a runny nose, sniffling, slight head ache.

Release 8 — day 42, dose 2

2021-05-04

Symptoms: Im tired more than usual. I also have had an eye infection for over four weeks.

Release 9 — 3 months, dose 2

2021-06-24

Symptoms: Allergy in my eyes.

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	Cough	✓	✓	✓
SD	Eye allergy	✓	✓	✓
SD	Eye infection	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	·	·	✓
SD	Headache	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Influenza like illness	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Sneezing	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Sneezing	✓	✓	✓

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