4LP-15837-78363

3 vaccinations 14 coded responses 33 check-ins 14 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 373 / TN
Registered: 2021-01-13

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

2021-01-13
Registered in v-safe
2021-01-13
Dose 1 — Moderna
2021-01-13
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia — Feeling: Fair · Site: Pain · Joint pains

Free text: Shoulder that got shot is better its my other shoulder that hurtd

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Joint pains

Adult check-in
2021-01-17
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia — Feeling: Good · Site: Pain · Diarrhea

Free text: Right shoulder has some pain, but my shot on left shoulder

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease, Rheumatoid arthritis — Feeling: Good · Joint pains, Muscle or body aches

Free text: My RA acts up some in shoulder and hands and back

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Survey response — day 7, dose 1
MedDRA: Back pain, Pain in extremity, Pre-existing disease, Rheumatoid arthritis — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Free text: My RA hurts in right arm and right leg and back

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Survey response — day 14, dose 1
MedDRA: Office visit, Tinnitus — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Ringing sound in my head · Healthcare visit (other): My health cate doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-03
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-10
Dose 2 — Moderna
2021-02-10
Survey response — day 0, dose 2
MedDRA: Constipation — Feeling: Good · Joint pains

Free text: Constipated somewhat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Fair · Site: Pain · Joint pains

Free text: Tired feeling

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Joint pains, Muscle or body aches

Free text: Normal R A pains

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease — Feeling: Good · Site: Itching · Muscle or body aches

Free text: Due to R A

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Joint pains, Muscle or body aches

Free text: Due to R A

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-17
Survey response — day 7, dose 2
MedDRA: Rheumatoid arthritis — Feeling: Good · Joint pains

Free text: R A joint pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Survey response — day 14, dose 2
MedDRA: Pre-existing disease, Rheumatoid arthritis — Feeling: Fair · Be unable to do your normal daily activities

Free text: R A flare up. Sore and stiff arm and legs and right hip

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-17
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-24
Survey response — day 42, dose 2
MedDRA: Tinnitus — Feeling: Fair

Free text: Tinnis. Ringing in my head or ears

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Call 1 — Left Voicemail
2021-05-12
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-11
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-10
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-10-08
Dose 3 — Moderna
Co-administered: Flu
2022-10-08
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2022-10-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-10-10
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Diarrhea

Adult check-in
2022-10-11
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Good · Diarrhea

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2022-10-13
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Diarrhea

Adult check-in
2022-10-15
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2023-01-07
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2023-04-08
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-13	Moderna
2	2021-02-10	Moderna
3	2022-10-08	Moderna	Flu

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-15

Systemic reaction (other): Shoulder that got shot is better its my other shoulder that hurtd

2021-01-17

Systemic reaction (other): Right shoulder has some pain, but my shot on left shoulder

2021-01-18

Systemic reaction (other): My RA acts up some in shoulder and hands and back

Release 2 — day 7, dose 1

2021-01-22

Systemic reaction (other): My RA hurts in right arm and right leg and back

Release 2 — day 14, dose 1

2021-01-27

Symptoms: Ringing sound in my head

Healthcare visit (other): My health cate doctor

Release 4 — day 0, dose 2

2021-02-10

Systemic reaction (other): Constipated somewhat

Release 4 — days 1–6 daily, dose 2

2021-02-11

Systemic reaction (other): Tired feeling

2021-02-12

Systemic reaction (other): Normal R A pains

2021-02-14

Systemic reaction (other): Due to R A

2021-02-15

Systemic reaction (other): Due to R A

Release 4 — day 7, dose 2

2021-02-17

Systemic reaction (other): R A joint pain

Release 4 — day 14, dose 2

2021-02-24

Symptoms: R A flare up. Sore and stiff arm and legs and right hip

Release 6 — day 42, dose 2

2021-03-24

Symptoms: Tinnis. Ringing in my head or ears

Release 12 — days 1–6 daily, dose 3

2022-10-11

Systemic reaction (other): No

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	Pre-existing disease	✓	✓	✓
SD	Rheumatoid arthritis	✓	✓	✓
SD	Tinnitus	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Constipation	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	No adverse event	·	·	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rheumatoid arthritis	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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