4BG-20939-56436

3 vaccinations 14 coded responses 36 check-ins 14 free-text entries 4 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 956 / CA
Registered: 2021-03-13

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

Timeline

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

2021-03-13
Registered in v-safe
2021-03-13
Dose 1 — Moderna
2021-03-13
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

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

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

Adult check-in
2021-03-20
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-27
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-03
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-11
Dose 2 — Moderna
2021-04-11
Survey response — day 0, dose 2
MedDRA: Dysgeusia, Hot flush, Hypertension, Paraesthesia, Pruritus, Rash pruritic — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Fatigue or tiredness, Nausea · 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: Pins and needles all over my body including my face, weird taste in my mouth, itchy spots all over my body,hot flashes, slightly high blood pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Report sent to call center — day 0, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-04-14
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in extremity — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: My hands and my feet hurt

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: Good · None

Adult check-in
2021-04-16
Survey response — days 1–6 daily, dose 2
MedDRA: Amnesia — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I have loss of memory

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-19
Survey response — day 7, dose 2
MedDRA: Amnesia — Feeling: Good · Be unable to work

Free text: Memory loss

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-02
Survey response — day 21, dose 2
MedDRA: Amnesia, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: I'm still having memory loss · Healthcare visit (other): Full blood work up and CT scan

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-09
Survey response — day 28, dose 2
MedDRA: Amnesia — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Memory loss

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-23
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-11
Survey response — 3 months, dose 2
MedDRA: Condition aggravated, Paranasal sinus hypersecretion, Pre-existing disease, Sinusitis — Feeling: Good

Free text: My sinuses have been draining for about a month and then they got flared up it looks like I had a sinus infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2022-01-14
Dose 3 — Moderna
2022-01-15
Survey response — days 1–6 daily, dose 3
MedDRA: Rash, Rash pruritic — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Itchy spots that come and go all over my body

MedDRA releases: 2024-11 · check-in free text available
2022-01-16
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: The lymph node in my armpit is swollen and hurts in my chest

MedDRA releases: 2024-11 · check-in free text available
2022-01-17
Survey response — days 1–6 daily, dose 3
MedDRA: Brain fog, Lymphadenopathy — Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Swollen lymph nodes and brain fog

MedDRA releases: 2024-11 · check-in free text available
2022-01-18
Survey response — days 1–6 daily, dose 3
MedDRA: Amnesia, Brain fog, Lymphadenopathy — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Lymph nodes swollen, memory loss or foggy

MedDRA releases: 2024-11 · check-in free text available
2022-01-19
Survey response — days 1–6 daily, dose 3
MedDRA: Amnesia, Lymphadenopathy — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Swollen lymph nodes and brain memory loss

MedDRA releases: 2024-11 · check-in free text available
2022-01-20
Survey response — days 1–6 daily, dose 3
MedDRA: Confusional state, Lymphadenopathy — Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Swollen lymph nodes and brain confusion

MedDRA releases: 2024-11 · check-in free text available
2022-01-21
Survey response — day 7, dose 3
MedDRA: Lymphadenopathy, Memory impairment — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Left loads are swollen and having trouble with my memory

MedDRA releases: 2024-11 · check-in free text available
2022-01-28
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-02-04
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-02-11
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-18
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-02-25
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-26
Call 1 — Could Not Reach Participant
2022-03-03
Call 2 — Left Voicemail
2022-04-15
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-07-15
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-13	Moderna
2	2021-04-11	Moderna
3	2022-01-14	Moderna	No

Call center

4 call center cases

4 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 7 — day 0, dose 2

2021-04-11

Systemic reaction (other): Pins and needles all over my body including my face, weird taste in my mouth, itchy spots all over my body,hot flashes, slightly high blood pressure

Release 7 — days 1–6 daily, dose 2

2021-04-14

Systemic reaction (other): My hands and my feet hurt

2021-04-16

Systemic reaction (other): I have loss of memory

Release 7 — day 7, dose 2

2021-04-19

Systemic reaction (other): Memory loss

Release 8 — day 21, dose 2

2021-05-02

Symptoms: I'm still having memory loss

Healthcare visit (other): Full blood work up and CT scan

Release 8 — day 28, dose 2

2021-05-09

Symptoms: Memory loss

Release 9 — 3 months, dose 2

2021-07-11

Symptoms: My sinuses have been draining for about a month and then they got flared up it looks like I had a sinus infection

Release 10 — days 1–6 daily, dose 3

2022-01-15

Systemic reaction (other): Itchy spots that come and go all over my body

2022-01-16

Systemic reaction (other): The lymph node in my armpit is swollen and hurts in my chest

2022-01-17

Systemic reaction (other): Swollen lymph nodes and brain fog

2022-01-18

Systemic reaction (other): Lymph nodes swollen, memory loss or foggy

2022-01-19

Systemic reaction (other): Swollen lymph nodes and brain memory loss

2022-01-20

Systemic reaction (other): Swollen lymph nodes and brain confusion

Release 11 — day 7, dose 3

2022-01-21

Systemic reaction (other): Left loads are swollen and having trouble with my memory

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
HCVO	Unevaluable event	✓	✓	✓
SD	Amnesia	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Paranasal sinus hypersecretion	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Sinusitis	✓	✓	✓
SRO	Amnesia	✓	✓	✓
SRO	Brain fog	·	·	✓
SRO	Confusional state	·	·	✓
SRO	Dysgeusia	✓	✓	✓
SRO	Hot flush	✓	✓	✓
SRO	Hypertension	✓	✓	✓
SRO	Lymph node pain	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Memory impairment	·	·	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	·	·	✓
SRO	Rash pruritic	✓	✓	✓

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