4H4-33070-13695

2 vaccinations 9 coded responses 19 check-ins 9 free-text entries 6 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 784 / TX
Registered: 2021-01-30

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-01-29
Dose 1 — Moderna
2021-01-30
Registered in v-safe
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness, Nausea

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-03
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Site: Pain · Headache

Free text: The pain is only slight if I press on the injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-07
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-13
Survey response — day 14, dose 1
MedDRA: Cranial nerve paralysis, Diplopia, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Double vision diagnosed as sixth cranial nerve palsy. · Healthcare visit (other): In office visit with general practitioner and second office visit with Opthamologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-19
Survey response — day 21, dose 1
MedDRA: Cranial nerve paralysis, Diplopia, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Double vision due to sixth cranial nerve palsy. · Healthcare visit (other): Opthamologist visit and follow up on Feb. 24.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-26
Survey response — day 28, dose 1
MedDRA: Diplopia, Office visit, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Still having double vision due to Opthamologist diagnosed sixth cranial nerve palsy. · Healthcare visit (other): Office visit and exam.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Report sent to call center — day 28, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-27
Dose 2 — Moderna
2021-03-05
Survey response — days 1–6 daily, dose 2
MedDRA: Cranial nerve paralysis, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): As commented before. Eight days after the first injection I was diagnosed with sixth cranial nerve palsy by an Opthamologist. · Healthcare visit (other): Office visit with Opthamologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-06
Survey response — day 7, dose 2
MedDRA: Office visit, VIth nerve paralysis — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Opthamologist diagnosed me with sixth cranial nerve palsy · Healthcare visit (other): Opthamologist office visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Report sent to call center — day 7, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-13
Survey response — day 14, dose 2
MedDRA: Cranial nerve paralysis, Eye disorder — Feeling: Good · Be unable to do your normal daily activities

Free text: Opthamologist diagnosed sixth cranial nerve palsy of my left eye.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — day 21, dose 2
MedDRA: Cranial nerve paralysis, Medical counselling — Feeling: Good · Be unable to do your normal daily activities

Free text: Opthamologist diagnosed condition of 6th cranial nerve palsy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — day 28, dose 2
MedDRA: Cranial nerve paralysis, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Opthamologist diagnosed sixth cranial nerve palsy. It has now almost 2 months. It started about 8 days after my first vaccine. · Healthcare visit (other): Opthamologist office visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-03
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-29
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-30
Call 1 — Left Voicemail
2021-08-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-03-01
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-29	Moderna
2	2021-02-27	Moderna

Call center

6 call center cases

6 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-03

Systemic reaction (other): The pain is only slight if I press on the injection site.

Release 4 — day 14, dose 1

2021-02-13

Symptoms: Double vision diagnosed as sixth cranial nerve palsy.

Healthcare visit (other): In office visit with general practitioner and second office visit with Opthamologist.

Release 4 — day 21, dose 1

2021-02-19

Symptoms: Double vision due to sixth cranial nerve palsy.

Healthcare visit (other): Opthamologist visit and follow up on Feb. 24.

Release 4 — day 28, dose 1

2021-02-26

Symptoms: Still having double vision due to Opthamologist diagnosed sixth cranial nerve palsy.

Healthcare visit (other): Office visit and exam.

Release 5 — days 1–6 daily, dose 2

2021-03-05

Systemic reaction (other): As commented before. Eight days after the first injection I was diagnosed with sixth cranial nerve palsy by an Opthamologist.

Healthcare visit (other): Office visit with Opthamologist

Release 5 — day 7, dose 2

2021-03-06

Systemic reaction (other): Opthamologist diagnosed me with sixth cranial nerve palsy

Healthcare visit (other): Opthamologist office visit

Release 5 — day 14, dose 2

2021-03-13

Symptoms: Opthamologist diagnosed sixth cranial nerve palsy of my left eye.

Release 6 — day 21, dose 2

2021-03-20

Symptoms: Opthamologist diagnosed condition of 6th cranial nerve palsy.

Release 6 — day 28, dose 2

2021-03-30

Symptoms: Opthamologist diagnosed sixth cranial nerve palsy. It has now almost 2 months. It started about 8 days after my first vaccine.

Healthcare visit (other): Opthamologist office visit

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	Office visit	✓	✓	✓
SD	Cranial nerve paralysis	✓	✓	✓
SD	Diplopia	✓	✓	✓
SD	Eye disorder	✓	✓	✓
SD	Medical counselling	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SRO	Cranial nerve paralysis	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Office visit	✓	✓	✓
SRO	VIth nerve paralysis	✓	✓	✓

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