4SE-15940-36318

3 vaccinations 9 coded responses 35 check-ins 9 free-text entries 3 call cases

Sex: Male
Age at first dose: 36-40
ZIP prefix: 800 / CO
Registered: 2021-02-05

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-05
Registered in v-safe
2021-02-05
Dose 1 — Moderna
2021-02-05
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Headache

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Muscle spasms — Feeling: Good · Headache

Free text: Muscle spasms in arm/side of body by injection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — day 7, dose 1
Feeling: Good · Headache

Adult check-in
2021-02-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-05
Dose 2 — Moderna
2021-03-05
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-03-06
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, Abdominal pain

Adult check-in
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site bruising — Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Free text: Bruising around the injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site bruising — Feeling: Good · Site: Pain, Redness

Free text: Brushing around injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site bruising — Feeling: Fair · Site: Pain · Headache · Be unable to do your normal daily activities

Free text: Bruising at injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site bruising — Feeling: Good · Headache, Fatigue or tiredness

Free text: Bruising around injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-18
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-04
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-22
Dose 3 — Moderna
2021-10-23
Survey response — days 1–6 daily, dose 3
MedDRA: Heart rate increased — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: High heart right while resting according to Apple Watch. 110bpm blips for a couple of hours.

MedDRA releases: 2024-11 · check-in free text available
2021-10-24
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-10-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-29
Health check-in — day 7, dose 3
Feeling: Good · Headache

Adult check-in
2021-11-05
Survey response — day 14, dose 3
MedDRA: Anaphylactic reaction, Pre-existing disease, Rash, Swelling, Urticaria — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Massive full body rash/urticaria, sought medical care. Presumed delayed rash from Moderna dose three allergy/anaphylaxis. First symptoms present day ten. With antihistamines, and steroids, by today day 14 rash/swelling under slowly subsiding.

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Report sent to call center — day 14, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-09
Call 1 — Could Not Reach Participant
2021-11-12
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-12
Call 2 — Could Not Reach Participant
2021-11-19
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-11-26
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-03
Survey response — day 42, dose 3
MedDRA: Influenza A virus test negative, Influenza B virus test, Pulmonary oedema, Rhinovirus infection, SARS-CoV-2 test negative, X-ray abnormal — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Rhinovirus of unknown origin. Fluvid done, negative for flu a/b, and RSV, along with covid. X-ray with light fluid in mid lungs.

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Report sent to call center — day 42, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-06
Call 1 — Could Not Reach Participant
2021-12-09
Call 2 — Could Not Reach Participant
2022-01-23
Survey response — 3 months, dose 3
MedDRA: Mechanical urticaria, Migraine, Pre-existing disease, Rash, Skin reaction — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Migraines flaring up more often, previous treatments less effective. Repercussions from the delayed rashing at day 11-20. Still histamine response with dermagraphy.

MedDRA releases: 2024-11 · check-in free text available
2022-01-23
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-24
Call 1 — Could Not Reach Participant
2022-01-27
Call 2 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-05	Moderna
3	2021-10-22	Moderna	No

Call center

3 call center cases

3 unsuccessful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-09

Systemic reaction (other): Muscle spasms in arm/side of body by injection

Release 5 — days 1–6 daily, dose 2

2021-03-07

Systemic reaction (other): Bruising around the injection site.

2021-03-08

Systemic reaction (other): Brushing around injection site.

2021-03-09

Systemic reaction (other): Bruising at injection site.

2021-03-11

Systemic reaction (other): Bruising around injection site

Release 10 — days 1–6 daily, dose 3

2021-10-23

Systemic reaction (other): High heart right while resting according to Apple Watch. 110bpm blips for a couple of hours.

Release 10 — day 14, dose 3

2021-11-05

Symptoms: Massive full body rash/urticaria, sought medical care. Presumed delayed rash from Moderna dose three allergy/anaphylaxis. First symptoms present day ten. With antihistamines, and steroids, by today day 14 rash/swelling under slowly subsiding.

Release 10 — day 42, dose 3

2021-12-03

Symptoms: Rhinovirus of unknown origin. Fluvid done, negative for flu a/b, and RSV, along with covid. X-ray with light fluid in mid lungs.

Release 11 — 3 months, dose 3

2022-01-23

Symptoms: Migraines flaring up more often, previous treatments less effective. Repercussions from the delayed rashing at day 11-20. Still histamine response with dermagraphy.

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	Anaphylactic reaction	·	·	✓
SD	Influenza A virus test negative	·	·	✓
SD	Influenza B virus test	·	·	✓
SD	Mechanical urticaria	·	·	✓
SD	Migraine	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pulmonary oedema	·	·	✓
SD	Rash	·	·	✓
SD	Rhinovirus infection	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Skin reaction	·	·	✓
SD	Swelling	·	·	✓
SD	Urticaria	·	·	✓
SD	X-ray abnormal	·	·	✓
SRO	Heart rate increased	·	·	✓
SRO	Injection site bruising	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓

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