4TL-20804-90408

3 vaccinations 14 coded responses 28 check-ins 14 free-text entries 0 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 480 / MI
Registered: 2021-01-25

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

2021-01-25
Registered in v-safe
2021-01-25
Dose 1 — Moderna
2021-01-25
Survey response — day 0, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Redness · Chills, Fatigue or tiredness

Free text: Lightheaded

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Mood swings — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Moody

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — days 1–6 daily, dose 1
MedDRA: Constipation — Feeling: Fair · Nausea, Abdominal pain

Free text: Constipation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-31
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness

Free text: none

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Survey response — day 7, dose 1
MedDRA: No adverse event — Feeling: Good · Nausea

Free text: None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-15
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-22
Dose 2 — Moderna
2021-02-22
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — days 1–6 daily, dose 2
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
2021-02-24
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Still tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Fatigue or tiredness

Adult check-in
2021-03-01
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-24
Survey response — day 28, dose 2
MedDRA: Abdominal discomfort, Gaze palsy, Myalgia, Somnolence — Feeling: Fair · Be unable to do your normal daily activities

Free text: Muscle aches, head ache upset stomach and difficulty staying awake.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-24
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Sleep disorder — Feeling: Fair · Be unable to do your normal daily activities

Free text: Increasing arthritic pain of spine, neck, shoulders and hips causing interruption of sleep.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-23
Survey response — 6 months, dose 2
MedDRA: Adenoid cystic carcinoma — Feeling: Good

Free text: I developed an ACC (Adenoid Cystic Carcinoma) growth in my right breast. I underwent surgery to remove it, margins are clear. According to my surgery team it is very rare in men.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-22
Dose 3 — Moderna
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: Sneezing — Feeling: Fair · Fatigue or tiredness

Free text: Frequent Sneezing

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2021-10-29
Survey response — day 7, dose 3
MedDRA: No adverse event — Feeling: Fair · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Survey response — day 14, dose 3
MedDRA: Urticaria — Feeling: Fair

Free text: Hives on torso and upper legs

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-25	Moderna
2	2021-02-22	Moderna
3	2021-10-22	Moderna	No

Free text

Release 2 — day 0, dose 1

2021-01-25

Systemic reaction (other): Lightheaded

Release 2 — days 1–6 daily, dose 1

2021-01-27

Systemic reaction (other): Moody

2021-01-28

Systemic reaction (other): Constipation

Release 3 — days 1–6 daily, dose 1

2021-01-31

Systemic reaction (other): none

Release 3 — day 7, dose 1

2021-02-01

Systemic reaction (other): None

Release 4 — day 0, dose 2

2021-02-22

Systemic reaction (other): No

Release 4 — days 1–6 daily, dose 2

2021-02-24

Systemic reaction (other): Still tired

2021-02-25

Systemic reaction (other): No

Release 6 — day 28, dose 2

2021-03-24

Symptoms: Muscle aches, head ache upset stomach and difficulty staying awake.

Release 8 — 3 months, dose 2

2021-05-24

Symptoms: Increasing arthritic pain of spine, neck, shoulders and hips causing interruption of sleep.

Release 9 — 6 months, dose 2

2021-08-23

Symptoms: I developed an ACC (Adenoid Cystic Carcinoma) growth in my right breast. I underwent surgery to remove it, margins are clear. According to my surgery team it is very rare in men.

Release 10 — days 1–6 daily, dose 3

2021-10-27

Systemic reaction (other): Frequent Sneezing

Release 10 — day 7, dose 3

2021-10-29

Systemic reaction (other): No

Release 10 — day 14, dose 3

2021-11-06

Symptoms: Hives on torso and upper legs

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	Abdominal discomfort	✓	✓	✓
SD	Adenoid cystic carcinoma	✓	·	✓
SD	Arthralgia	✓	✓	✓
SD	Gaze palsy	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Sleep disorder	✓	✓	✓
SD	Somnolence	✓	✓	✓
SD	Urticaria	·	·	✓
SRO	Constipation	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Mood swings	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Sneezing	·	·	✓

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