4FJ-75794-15297

2 vaccinations 13 coded responses 18 check-ins 13 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 121 / NY
Registered: 2021-02-19

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

2021-02-19
Registered in v-safe
2021-02-19
Dose 1 — Moderna
2021-02-19
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-02-21
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus, Sinus disorder, Sneezing — Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Free text: Sneezing,, itchy upper sinuses

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea, Sneezing — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Difficulty breathing, sneezing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal discomfort, Throat clearing — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Can't clear throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea, Dyspnoea exertional — Feeling: Good · Fatigue or tiredness

Free text: Trouble breathing when walking.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Lack of breath.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-05
Survey response — day 14, dose 1
MedDRA: Gait disturbance, Musculoskeletal stiffness — Feeling: Fair

Free text: Trouble walking/leg stiffness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — day 21, dose 1
MedDRA: Dyspnoea, Fatigue, Medical observation — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: More tired, out of breath. · Healthcare visit (other): Primary doctor check-up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Survey response — day 28, dose 1
MedDRA: Dyspnoea, Fatigue — Feeling: Fair

Free text: Loss of breath, easily tired.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Dose 2 — Moderna
2021-04-02
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-04-06
Survey response — day 14, dose 2
MedDRA: Nausea — Feeling: Fair

Free text: Nausea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Survey response — day 21, dose 2
MedDRA: Localised infection, Pain in extremity — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Toe infection and pain.

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

1 call case(s)
2021-04-27
Survey response — day 35, dose 2
MedDRA: Dyspnoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Harder to breathe when standing.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Survey response — day 42, dose 2
MedDRA: Dyspnoea, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: More breathy. · Healthcare visit (other): Have appointment with pulmonologist in May.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-20
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-19
Survey response — 6 months, dose 2
MedDRA: Chapped lips, Cheilitis, Lip discolouration, Lip swelling, Nausea, Skin weeping, Stevens-Johnson syndrome, Swelling — 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, Emergency room or emergency department visit, Hospitalization

Free text: steven-johnson syndrone. Swollen lower lip plus spots and rashes that crack and ooze. Also, have had nouts og nausea.

MedDRA releases: 2024-11 · check-in free text available
2021-09-19
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-20
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-19	Moderna
2	2021-03-21	Moderna

Call center

4 call center cases

4 unsuccessful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-21

Systemic reaction (other): Sneezing,, itchy upper sinuses

2021-02-22

Systemic reaction (other): Difficulty breathing, sneezing

2021-02-23

Systemic reaction (other): Can't clear throat

2021-02-24

Systemic reaction (other): Trouble breathing when walking.

2021-02-25

Systemic reaction (other): Lack of breath.

Release 5 — day 14, dose 1

2021-03-05

Symptoms: Trouble walking/leg stiffness.

Release 5 — day 21, dose 1

2021-03-12

Symptoms: More tired, out of breath.

Healthcare visit (other): Primary doctor check-up

Release 5 — day 28, dose 1

2021-03-19

Symptoms: Loss of breath, easily tired.

Release 7 — day 14, dose 2

2021-04-06

Symptoms: Nausea

Release 7 — day 21, dose 2

2021-04-11

Symptoms: Toe infection and pain.

Release 8 — day 35, dose 2

2021-04-27

Symptoms: Harder to breathe when standing.

Release 8 — day 42, dose 2

2021-05-02

Symptoms: More breathy.

Healthcare visit (other): Have appointment with pulmonologist in May.

Release 9 — 6 months, dose 2

2021-09-19

Symptoms: steven-johnson syndrone. Swollen lower lip plus spots and rashes that crack and ooze. Also, have had nouts og nausea.

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	Medical observation	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Chapped lips	·	·	✓
SD	Cheilitis	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gait disturbance	✓	✓	✓
SD	Lip discolouration	·	·	✓
SD	Lip swelling	·	·	✓
SD	Localised infection	✓	✓	✓
SD	Musculoskeletal stiffness	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Skin weeping	·	·	✓
SD	Stevens-Johnson syndrome	·	·	✓
SD	Swelling	·	·	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Dyspnoea exertional	✓	✓	✓
SRO	Oropharyngeal discomfort	✓	✓	○
SRO	Pruritus	✓	✓	✓
SRO	Sinus disorder	✓	✓	✓
SRO	Sneezing	✓	✓	✓
SRO	Throat clearing	·	·	✓

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