4SS-17101-79089

5 vaccinations 13 coded responses 36 check-ins 11 free-text entries 1 call case

Sex: Male
Age at first dose: 61-65
ZIP prefix: 330 / FL
Registered: 2021-03-29

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

2021-03-29
Registered in v-safe
2021-03-29
Dose 1 — Moderna
2021-03-29
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-03-30
Survey response — days 1–6 daily, dose 1
MedDRA: Blood pressure decreased — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities

Free text: Blood pressure went down to 86/95

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · None

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-04-05
Health check-in — day 7, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-04-12
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-04-19
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-04-27
Dose 2 — Moderna
2021-04-27
Survey response — day 0, dose 2
MedDRA: Tachycardia — Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Tachycardia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-04-29
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site erythema — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Red spot 4 inches in diameter on injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Pain — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Yesterday circular red irritation in the injected area has become an irregular shape red patch. Mild pain remains in the affected area.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-01
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site erythema — Feeling: Fair · Site: Redness · Muscle or body aches

Free text: The redness in the injected area is fading away.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema — Feeling: Fair · Site: Redness · Muscle or body aches

Free text: Redness starting gradually fading

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema — Feeling: Fair · Site: Redness · Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: Redness gradually decreased in the injected arm area

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Survey response — day 7, dose 2
MedDRA: Injection site erythema — Feeling: Fair · Site: Redness · Muscle or body aches

Free text: Redness gradually decreasing in the injected area

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-18
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-25
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-06-01
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-06-08
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-28
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-10-26
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-01-12
Dose 3 — Moderna
2022-04-27
Survey response — 12 months, dose 2
MedDRA: Bronchial irritation, Eye irritation, Eye pruritus, Headache, Nasopharyngitis, Pre-existing disease, Throat irritation — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Strange cold/allergy that starts throat and bronchial irritation, headache, itchy and irritation on both eyes

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Dose 4 — Moderna
2022-06-12
Survey response — day 21, dose 4
MedDRA: Headache, Myalgia, Tachycardia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Muscle pain, headache and tachycardia

MedDRA releases: 2024-11 · check-in free text available
2022-06-14
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-06-21
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-06-28
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-08-17
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-11-15
Survey response — 6 months, dose 4
MedDRA: Dry throat, Influenza, Productive cough, Secretion discharge, Smoke sensitivity, Upper respiratory tract congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: New symptoms of flu 4 weeks ago. Dry throat, sensitive to smoke including incense, and upper respiratory congestion with phlegm and mucus. Anteropro and cooling severe nighttime cold and flu medicine reverse the symptoms.

MedDRA releases: 2024-11 · check-in free text available
2023-04-18
Dose 5 — Moderna
2023-05-09
Survey response — day 21, dose 5
MedDRA: Aortic stenosis, Cardiac murmur, Echocardiogram abnormal — Feeling: Fair

MedDRA releases: 2024-11
2023-05-16
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2023-05-23
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2023-05-30
Survey response — day 42, dose 5
MedDRA: Cardiac murmur, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-05-30
Call case (no matching report) — Unsuccessful
2023-05-31
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-29	Moderna
2	2021-04-27	Moderna
3	2022-01-12	Moderna	No
4	2022-05-17	Moderna	No
5	2023-04-18	Moderna	No

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-30

Systemic reaction (other): Blood pressure went down to 86/95

Release 8 — day 0, dose 2

2021-04-27

Systemic reaction (other): Tachycardia

Release 8 — days 1–6 daily, dose 2

2021-04-29

Systemic reaction (other): Red spot 4 inches in diameter on injection site

2021-04-30

Systemic reaction (other): Yesterday circular red irritation in the injected area has become an irregular shape red patch. Mild pain remains in the affected area.

2021-05-01

Systemic reaction (other): The redness in the injected area is fading away.

2021-05-02

Systemic reaction (other): Redness starting gradually fading

2021-05-03

Systemic reaction (other): Redness gradually decreased in the injected arm area

Release 8 — day 7, dose 2

2021-05-04

Systemic reaction (other): Redness gradually decreasing in the injected area

Release 11 — 12 months, dose 2

2022-04-27

Symptoms: Strange cold/allergy that starts throat and bronchial irritation, headache, itchy and irritation on both eyes

Release 12 — day 21, dose 4

2022-06-12

Symptoms: Muscle pain, headache and tachycardia

Release 12 — 6 months, dose 4

2022-11-15

Symptoms: New symptoms of flu 4 weeks ago. Dry throat, sensitive to smoke including incense, and upper respiratory congestion with phlegm and mucus. Anteropro and cooling severe nighttime cold and flu medicine reverse the symptoms.

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	Aortic stenosis	·	·	✓
SD	Bronchial irritation	·	·	✓
SD	Cardiac murmur	·	·	✓
SD	Dry throat	·	·	✓
SD	Echocardiogram abnormal	·	·	✓
SD	Eye irritation	·	·	✓
SD	Eye pruritus	·	·	✓
SD	Headache	·	·	✓
SD	Influenza	·	·	✓
SD	Myalgia	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Productive cough	·	·	✓
SD	Secretion discharge	·	·	✓
SD	Smoke sensitivity	·	·	✓
SD	Tachycardia	·	·	✓
SD	Throat irritation	·	·	✓
SD	Upper respiratory tract congestion	·	·	✓
SRO	Blood pressure decreased	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Injection site erythema	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Tachycardia	✓	✓	✓

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