483-34528-01435

4 vaccinations 18 coded responses 46 check-ins 18 free-text entries 2 call cases

Sex: Male
Age at first dose: 41-45
ZIP prefix: 103 / NY
Registered: 2021-01-08

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-01-06
Dose 1 — Moderna
2021-01-08
Registered in v-safe
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-10
Survey response — days 1–6 daily, dose 1
MedDRA: Lung disorder — Feeling: Fair · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lung tightness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-10
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-14
Health check-in — day 7, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-01-20
Survey response — day 14, dose 1
MedDRA: Dizziness, Headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Headache and dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-03
Dose 2 — Moderna
2021-02-03
Survey response — day 0, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Chills, Headache · Be unable to do your normal daily activities

Free text: Lightheaded

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Parosmia — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Change in smell for a few hours. Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Hyperhidrosis — Feeling: Good · Site: Pain · Chills, Headache

Free text: Dizziness, feeling sweaty

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 2
MedDRA: Brain fog, Depressed level of consciousness — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Mental cloudiness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — day 7, dose 2
Feeling: Good · Chills, Headache

Adult check-in
2021-02-21
Survey response — day 14, dose 2
MedDRA: Injection site pain, Palpitations — Feeling: Good · Be unable to work

Free text: Arm pain at injection site and palpitations

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — day 21, dose 2
MedDRA: Pain in extremity, Pruritus, Rash — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Left arm pain, rash amd itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-03
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-10
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-17
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-05
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-05-31
Call 1 — Left Voicemail
2021-08-06
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-03
Dose 3 — Moderna
2021-12-04
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-12-05
Survey response — days 1–6 daily, dose 3
MedDRA: Chest pain, Dizziness — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizziness and intermittent chest left upper chest pain. Feels sharp.

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Dizziness

MedDRA releases: 2024-11 · check-in free text available
2021-12-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-12-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-10
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-18
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-24
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-31
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-07
Survey response — day 35, dose 3
MedDRA: Fatigue — Feeling: Fair

Free text: Fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-01-14
Survey response — day 42, dose 3
MedDRA: Dizziness, Headache, Rhinorrhoea — Feeling: Fair

Free text: Running nose, headache, dizziness

MedDRA releases: 2024-11 · check-in free text available
2022-03-04
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-03
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-07
Dose 4 — Moderna
2022-10-08
Survey response — days 1–6 daily, dose 4
MedDRA: Dizziness — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizzy

MedDRA releases: 2024-11 · check-in free text available
2022-10-09
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-10
Survey response — days 1–6 daily, dose 4
MedDRA: Dizziness, Pallor — Feeling: Fair · Site: Pain · Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Dizzy and people have told me I look pale.

MedDRA releases: 2024-11 · check-in free text available
2022-10-11
Survey response — days 1–6 daily, dose 4
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2024-11 · check-in free text available
2022-10-13
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-10-14
Survey response — day 7, dose 4
MedDRA: Brain fog — Feeling: Good · Fatigue or tiredness

Free text: Mental foggy

MedDRA releases: 2024-11 · check-in free text available
2022-10-21
Survey response — day 14, dose 4
MedDRA: Asthma, Pre-existing disease, SARS-CoV-2 test negative, Viral infection — Feeling: Fair · Be unable to work or attend school

Free text: Some type of viral infection that caused an asthma exacerbation. Covid test were negative

MedDRA releases: 2024-11 · check-in free text available
2022-10-30
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-04
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-11
Survey response — day 35, dose 4
MedDRA: Cough — Feeling: Good

Free text: Cough

MedDRA releases: 2024-11 · check-in free text available
2022-11-20
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-01-08
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-04-07
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-06	Moderna
2	2021-02-03	Moderna
3	2021-12-03	Moderna	No
4	2022-10-07	Moderna	No

Call center

2 call center cases

1 unsuccessful · 1 priority 2/3 (triaged and no follow up)

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-10

Systemic reaction (other): Lung tightness

Release 2 — day 14, dose 1

2021-01-20

Symptoms: Headache and dizziness

Release 3 — day 0, dose 2

2021-02-03

Systemic reaction (other): Lightheaded

Release 3 — days 1–6 daily, dose 2

2021-02-04

Systemic reaction (other): Change in smell for a few hours. Dizziness

2021-02-05

Systemic reaction (other): Dizziness, feeling sweaty

2021-02-09

Systemic reaction (other): Mental cloudiness

Release 4 — day 14, dose 2

2021-02-21

Symptoms: Arm pain at injection site and palpitations

Release 4 — day 21, dose 2

2021-02-25

Symptoms: Left arm pain, rash amd itching

Release 10 — days 1–6 daily, dose 3

2021-12-05

Systemic reaction (other): Dizziness and intermittent chest left upper chest pain. Feels sharp.

2021-12-06

Systemic reaction (other): Dizziness

Release 10 — day 35, dose 3

2022-01-07

Symptoms: Fatigue

Release 10 — day 42, dose 3

2022-01-14

Symptoms: Running nose, headache, dizziness

Release 12 — days 1–6 daily, dose 4

2022-10-08

Systemic reaction (other): Dizzy

2022-10-10

Systemic reaction (other): Dizzy and people have told me I look pale.

2022-10-11

Systemic reaction (other): Dizziness

Release 12 — day 7, dose 4

2022-10-14

Systemic reaction (other): Mental foggy

Release 12 — day 14, dose 4

2022-10-21

Symptoms: Some type of viral infection that caused an asthma exacerbation. Covid test were negative

Release 12 — day 35, dose 4

2022-11-11

Symptoms: Cough

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	Asthma	·	·	✓
SD	Cough	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Palpitations	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Viral infection	·	·	✓
SRO	Brain fog	·	·	✓
SRO	Chest pain	·	·	✓
SRO	Depressed level of consciousness	✓	✓	○
SRO	Dizziness	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Lung disorder	✓	✓	✓
SRO	Pallor	·	·	✓
SRO	Parosmia	✓	✓	✓

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