4DJ-24469-47590

2 vaccinations 8 coded responses 25 check-ins 8 free-text entries 0 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 800 / CO
Registered: 2021-03-04

Relationship: Self
Race: White
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 — Moderna
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: Dizziness — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Mild lightheadedness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Survey response — days 1–6 daily, dose 1
MedDRA: Body temperature decreased, Dizziness, Peripheral swelling — Feeling: Poor · Site: Pain, Redness · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Lightheadedness at times, swollen feet, body temp was 96.4Â° F this morning came up to 98.1Â°F at around noon

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness · Muscle or body aches, Fatigue or tiredness

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

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-12
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain, Redness · Chills

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

Adult check-in
2021-03-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-01
Dose 2 — Moderna
2021-04-01
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-04-03
Survey response — days 1–6 daily, dose 2
MedDRA: Joint swelling, Peripheral swelling — Feeling: Fair · Site: Pain, Redness, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Swollen feet, ankles and lower legs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Joint swelling, Peripheral swelling — Feeling: Fair · Site: Pain, Redness · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Feet, ankles and calves still swollen, but 50% better.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Peripheral swelling — Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Feet still swollen and some light headedness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 7, dose 2
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2021-04-15
Survey response — day 14, dose 2
MedDRA: Fatigue, Joint swelling, Pain in extremity, Peripheral swelling — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue, swollen feet/ankles/ calves.Arm pain in arm of injection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-07
Survey response — day 35, dose 2
MedDRA: Arthralgia, Asthenia, Vitreous detachment — Feeling: Good · Be unable to do your normal daily activities

Free text: Shoulder of vaccine shot more sore, also pvd in right eye, likely not side effect of vaccine. But weakness and pain in left shoulder might be.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-01
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-09-30
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-04-03
Survey response — 12 months, dose 2
MedDRA: Back pain, Depressed mood, Fatigue, Myalgia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Tired, depressed, back pain and pain in hamstring - back of left thigh.

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-04	Moderna
2	2021-04-01	Moderna

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-05

Systemic reaction (other): Mild lightheadedness

2021-03-06

Systemic reaction (other): Lightheadedness at times, swollen feet, body temp was 96.4Â° F this morning came up to 98.1Â°F at around noon

Release 6 — days 1–6 daily, dose 2

2021-04-03

Systemic reaction (other): Swollen feet, ankles and lower legs

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): Feet, ankles and calves still swollen, but 50% better.

2021-04-07

Systemic reaction (other): Feet still swollen and some light headedness.

Release 7 — day 14, dose 2

2021-04-15

Symptoms: Fatigue, swollen feet/ankles/ calves.Arm pain in arm of injection.

Release 8 — day 35, dose 2

2021-05-07

Symptoms: Shoulder of vaccine shot more sore, also pvd in right eye, likely not side effect of vaccine. But weakness and pain in left shoulder might be.

Release 11 — 12 months, dose 2

2022-04-03

Symptoms: Tired, depressed, back pain and pain in hamstring - back of left thigh.

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	Asthenia	✓	✓	✓
SD	Back pain	·	·	✓
SD	Depressed mood	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Joint swelling	✓	✓	✓
SD	Myalgia	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Vitreous detachment	✓	✓	✓
SRO	Body temperature decreased	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Joint swelling	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓

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