4KV-21522-11369

3 vaccinations 5 coded responses 37 check-ins 5 free-text entries 0 call cases

Sex: Male
Age at first dose: 36-40
ZIP prefix: 537 / WI
Registered: 2021-03-20

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

2021-03-20
Registered in v-safe
2021-03-20
Dose 1 — Moderna
2021-03-20
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-03-27
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-17
Dose 2 — Moderna
2021-04-17
Health check-in — day 0, dose 2
Feeling: Good · Site: Swelling · None

Adult check-in
2021-04-19
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Hot flush, Lethargy, Pain, Pain in extremity — Feeling: Good · Site: Pain

Free text: yesterday's link arrived about midnight and expired before I awoke, so I was unable to report symptoms. yesterday I had moderate arm pain, chills and hot flashes, lethargy and body aches. today I only have mild arm pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-24
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-03
Survey response — day 14, dose 2
MedDRA: Limb discomfort, Pain in extremity — Feeling: Fair

Free text: Shooting arm pain (moderate) at injection site after heavy arm exercise (26 pitches of climbing) on Saturday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-08
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-15
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-22
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-29
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-19
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-16
Survey response — 6 months, dose 2
MedDRA: Nasopharyngitis, SARS-CoV-2 test negative — Feeling: Good

Free text: Had a cold, negative COVID-19 test concurrent with symptoms

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Dose 3 — Moderna
2021-11-03
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-11-10
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-17
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-25
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-02
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-04
Survey response — 6 months, dose 3
MedDRA: Influenza, Nasopharyngitis, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Cold bug, flu big, neither was COVID per testing

MedDRA releases: 2024-11 · check-in free text available
2022-11-07
Survey response — 12 months, dose 3
MedDRA: Oropharyngeal pain — Feeling: Good

Free text: Sore throat for one day

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-20	Moderna
2	2021-04-17	Moderna
3	2021-11-03	Moderna	No

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-19

Systemic reaction (other): yesterday's link arrived about midnight and expired before I awoke, so I was unable to report symptoms. yesterday I had moderate arm pain, chills and hot flashes, lethargy and body aches. today I only have mild arm pain.

Release 8 — day 14, dose 2

2021-05-03

Symptoms: Shooting arm pain (moderate) at injection site after heavy arm exercise (26 pitches of climbing) on Saturday

Release 10 — 6 months, dose 2

2021-10-16

Symptoms: Had a cold, negative COVID-19 test concurrent with symptoms

Release 11 — 6 months, dose 3

2022-05-04

Symptoms: Cold bug, flu big, neither was COVID per testing

Release 12 — 12 months, dose 3

2022-11-07

Symptoms: Sore throat for one day

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	Influenza	·	·	✓
SD	Limb discomfort	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Chills	✓	✓	✓
SRO	Hot flush	✓	✓	✓
SRO	Lethargy	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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