4FT-11120-02546

2 vaccinations 5 coded responses 25 check-ins 5 free-text entries 5 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 188 / PA
Registered: 2021-03-15

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

2021-03-15
Registered in v-safe
2021-03-15
Dose 1 — Moderna
2021-03-15
Health check-in — day 0, dose 1
Feeling: Good · Headache

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

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Diarrhea

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 — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-12
Dose 2 — Moderna
2021-04-12
Health check-in — day 0, dose 2
Feeling: Fair · Nausea

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

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-27
Survey response — day 14, dose 2
MedDRA: Hypoaesthesia, Paraesthesia — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Intermittant numbness & tingling in right hand and arm up to shoulder. Began right after receiving 2nd vaccine. Didn't think of reaction to vaccine. Injection was given in left arm. Going for EMG this week. If normal, PCP not sure what is cause.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-03
Survey response — day 21, dose 2
MedDRA: Paraesthesia — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Recurrent numbness & tingling right arm and hand from shoulder to finger tips. EMG normal. Further diagnostics in progress. Neurologist believes it is neuropathy due to COVID vaccination as it began a couple days after receiving 2nd vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-10
Survey response — day 28, dose 2
MedDRA: Arthralgia, Hypoaesthesia, Pain in extremity, Paraesthesia — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Numbness, tingling & pain in the right arm from shoulder to thumb & index finger tips.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-17
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-05-24
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-07
Call 1 — Left Voicemail
2021-10-11
Survey response — 6 months, dose 2
MedDRA: Arrhythmia, Chest discomfort, Supraventricular extrasystoles, Ventricular extrasystoles — 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: Cardiac dysrhythmias: frequent PAC's & frequent PVC's. Increases with activity. Had frequent episodes of chest pressure mostly eased with rest but had to take Nitroglycerin SL for some relief. Cardiac cath negative for any blockages.

MedDRA releases: 2024-11 · check-in free text available
2021-10-11
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

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-10-12
Call 1 — Left Voicemail
2021-10-15
Call successful
Participant prefers to complete VAERS report online
2022-04-12
Survey response — 12 months, dose 2
MedDRA: Extrasystoles, Myocarditis, Ventricular extrasystoles — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Sequelae of myocarditis. Significant cardiac ectopy, very frequent PVC's, frequent quadgeminy, trigeminy & bigeminy. Occurs with any activity and at rest. Being followed by (b)(6)Clinic COVID-19 Recovery Center.

MedDRA releases: 2024-11 · check-in free text available
2022-04-12
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-04-14
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-15	Moderna
2	2021-04-12	Moderna

Call center

5 call center cases

5 successful

See the call center timeline

Free text

Release 8 — day 14, dose 2

2021-04-27

Symptoms: Intermittant numbness & tingling in right hand and arm up to shoulder. Began right after receiving 2nd vaccine. Didn't think of reaction to vaccine. Injection was given in left arm. Going for EMG this week. If normal, PCP not sure what is cause.

Release 8 — day 21, dose 2

2021-05-03

Symptoms: Recurrent numbness & tingling right arm and hand from shoulder to finger tips. EMG normal. Further diagnostics in progress. Neurologist believes it is neuropathy due to COVID vaccination as it began a couple days after receiving 2nd vaccine.

Release 8 — day 28, dose 2

2021-05-10

Symptoms: Numbness, tingling & pain in the right arm from shoulder to thumb & index finger tips.

Release 10 — 6 months, dose 2

2021-10-11

Symptoms: Cardiac dysrhythmias: frequent PAC's & frequent PVC's. Increases with activity. Had frequent episodes of chest pressure mostly eased with rest but had to take Nitroglycerin SL for some relief. Cardiac cath negative for any blockages.

Release 11 — 12 months, dose 2

2022-04-12

Symptoms: Sequelae of myocarditis. Significant cardiac ectopy, very frequent PVC's, frequent quadgeminy, trigeminy & bigeminy. Occurs with any activity and at rest. Being followed by (b)(6)Clinic COVID-19 Recovery Center.

redacted (b)(6)

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	Arrhythmia	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Chest discomfort	·	·	✓
SD	Extrasystoles	·	·	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Myocarditis	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Paraesthesia	✓	✓	✓
SD	Supraventricular extrasystoles	·	·	✓
SD	Ventricular extrasystoles	·	·	✓

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