4TF-28893-10157

3 vaccinations 13 coded responses 31 check-ins 13 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 912 / CA
Registered: 2021-04-06

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

Timeline

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

2021-04-06
Registered in v-safe
2021-04-06
Dose 1 — Moderna
2021-04-06
Survey response — day 0, dose 1
MedDRA: Injection site hypoaesthesia — Feeling: Good

Free text: Gentle Numbness in arm of vaccine application

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 1
MedDRA: Agitation, Nervousness — Feeling: Good · Fatigue or tiredness

Free text: Agitation- nervousness around 3PM till 4PM

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-04-10
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling hot, Formication — Feeling: Fair · Site: Itching · Chills, Fatigue or tiredness

Free text: Feeling overheated, skin crawling on and off

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-13
Survey response — day 7, dose 1
MedDRA: Pulmonary congestion, Self-medication — Feeling: Good · Fatigue or tiredness

Free text: Some lung congestion, Claritin helpful.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-04
Dose 2 — Moderna
2021-05-04
Survey response — day 0, dose 2
MedDRA: Injection site hypoaesthesia — Feeling: Good

Free text: Injection arm slightly numb for half hour only

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Survey response — days 1–6 daily, dose 2
MedDRA: Agitation — Feeling: Poor · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Agitation started 4AM. Had to walk outside in cold air for 1 hour

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Survey response — days 1–6 daily, dose 2
MedDRA: Agitation, Nervousness — Feeling: Fair · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Nervous agitation around 4AM-5AM

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Survey response — days 1–6 daily, dose 2
MedDRA: Anxiety — Feeling: Good · Fever · Fatigue or tiredness

Free text: Anxious agitation around 4-5AM, as if coffee overdose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Chills

Adult check-in
2021-05-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-11
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-01
Survey response — day 28, dose 2
MedDRA: Arthralgia, Joint swelling — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Sudden onset of pain and swelling in joints of thumb and first finger on both hands, like severe arthritis attack.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-08
Survey response — day 35, dose 2
MedDRA: Arthralgia, Swelling — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Sudden onset of gout-like joint pain/swelling in both thumbs and first fingers on both hands, has been bothering me for about 7-8 days now.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-15
Survey response — day 42, dose 2
MedDRA: Dysuria — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Increased difficulty in urinating

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-15
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-03
Survey response — 3 months, dose 2
MedDRA: Brain fog, Fatigue, Joint stiffness, Temperature intolerance — Feeling: Good

Free text: More fatigue than usual. Greater sensitivity to heat(weather) and humidity than a year ago, some joint stiffness, slight mental fog that could be hot weather related.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-02
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-03-31
Dose 3 — Moderna
2022-05-01
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-05-05
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-05-12
Survey response — day 42, dose 3
MedDRA: Arthralgia, Periarthritis, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Joint pain in knees and left frozen shoulder · Healthcare visit (other): In person doctor visit already scheduled

MedDRA releases: 2024-11 · check-in free text available
2022-05-12
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-13
Call 1 — Left Voicemail
2022-05-13
Call 1 — Left Voicemail
2022-05-16
Call successful
Does not wish to fill out VAERS report
2022-06-16
Call successful
Does not wish to fill out VAERS report
2022-06-30
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-09-29
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2023-03-31
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-06	Moderna
2	2021-05-04	Moderna
3	2022-03-31	Moderna	No

Call center

2 call center cases

2 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 7 — day 0, dose 1

2021-04-06

Systemic reaction (other): Gentle Numbness in arm of vaccine application

Release 7 — days 1–6 daily, dose 1

2021-04-07

Systemic reaction (other): Agitation- nervousness around 3PM till 4PM

2021-04-10

Systemic reaction (other): Feeling overheated, skin crawling on and off

Release 7 — day 7, dose 1

2021-04-13

Systemic reaction (other): Some lung congestion, Claritin helpful.

Release 8 — day 0, dose 2

2021-05-04

Systemic reaction (other): Injection arm slightly numb for half hour only

Release 8 — days 1–6 daily, dose 2

2021-05-05

Systemic reaction (other): Agitation started 4AM. Had to walk outside in cold air for 1 hour

2021-05-06

Systemic reaction (other): Nervous agitation around 4AM-5AM

2021-05-07

Systemic reaction (other): Anxious agitation around 4-5AM, as if coffee overdose

Release 8 — day 28, dose 2

2021-06-01

Symptoms: Sudden onset of pain and swelling in joints of thumb and first finger on both hands, like severe arthritis attack.

Release 8 — day 35, dose 2

2021-06-08

Symptoms: Sudden onset of gout-like joint pain/swelling in both thumbs and first fingers on both hands, has been bothering me for about 7-8 days now.

Release 9 — day 42, dose 2

2021-06-15

Symptoms: Increased difficulty in urinating

Release 9 — 3 months, dose 2

2021-08-03

Symptoms: More fatigue than usual. Greater sensitivity to heat(weather) and humidity than a year ago, some joint stiffness, slight mental fog that could be hot weather related.

Release 11 — day 42, dose 3

2022-05-12

Symptoms: Joint pain in knees and left frozen shoulder

Healthcare visit (other): In person doctor visit already scheduled

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	Unevaluable event	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Brain fog	✓	·	✓
SD	Dysuria	✓	✓	✓
SD	Fatigue	✓	·	✓
SD	Joint stiffness	✓	·	✓
SD	Joint swelling	✓	✓	✓
SD	Periarthritis	·	·	✓
SD	Swelling	✓	✓	✓
SD	Temperature intolerance	✓	·	✓
SRO	Agitation	✓	✓	✓
SRO	Anxiety	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Formication	✓	✓	✓
SRO	Injection site hypoaesthesia	✓	✓	✓
SRO	Nervousness	✓	✓	✓
SRO	Pulmonary congestion	✓	✓	✓
SRO	Self-medication	✓	✓	✓

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