4UF-16464-62506

2 vaccinations 15 coded responses 19 check-ins 15 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 440 / OH
Registered: 2021-01-16

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

2021-01-16
Registered in v-safe
2021-01-16
Dose 1 — Moderna
2021-01-16
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Survey response — days 1–6 daily, dose 1
MedDRA: Pyrexia — Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness

Free text: Felt feverish, temp was only 97.3

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fever · Headache

Adult check-in
2021-01-21
Survey response — days 1–6 daily, dose 1
MedDRA: Cardiac failure congestive, Dyspnoea, Pre-existing disease — Feeling: Fair

Free text: This morning when I got up about 6am I was having trouble breathing. This was like my CHF problem I have been having the past 10 months. I took my mastic and other meds and by noon I felt better. The rest of the d

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Good · Site: Pain

Free text: Tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Survey response — day 7, dose 1
MedDRA: Adverse reaction — Feeling: Good · Fatigue or tiredness

Free text: Breathing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-06
Survey response — day 21, dose 1
MedDRA: Cough, Pyrexia, Throat irritation — Feeling: Good

Free text: Friday morning I felt feverish, but had no fever. For the last 5 days I would start coughing for about 3-5 minutes, felt like a throat irritation, then it would go away, but it keeps coming back about 2 or 3 times a day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Survey response — day 28, dose 1
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Good

Free text: I am on Lasic for CHF and breathing problems. This week the systems were more pronounced in the evenings. But I would feel better after taking the lasic pill. I have had this CHF since April.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Dose 2 — Moderna
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Feeling abnormal, Pyrexia — Feeling: Fair · Fever · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: On Thursday I had a feverish feeling but no temp. Also my joints were aching and I felt bad

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Dizziness — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: Dizziness after sitting, unbalancing feeling, usually Waite a few seconds or move slower.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Survey response — day 7, dose 2
MedDRA: Fatigue — Feeling: Good · Fatigue or tiredness

Free text: Tiredness, took a nap which lasted 3 hours. Very unusual for me.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Survey response — day 14, dose 2
MedDRA: Pyrexia — Feeling: Good

Free text: On sat I felt a little feverish. But ok now.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — day 21, dose 2
MedDRA: Dyspnoea — Feeling: Good

Free text: Shortness of breath. Not sure if related to covid shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-22
Survey response — day 35, dose 2
MedDRA: Asthenia, Somnolence — Feeling: Good

Free text: Low energy, wanting to nap a lot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Survey response — day 42, dose 2
MedDRA: Adverse reaction — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Hard bowel movement.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-17
Survey response — 3 months, dose 2
MedDRA: Chest discomfort, Dizziness, Pre-existing disease — Feeling: Fair

Free text: Dizziness, tightness of my chest due I think to my congested heart failure. Im taking Lasic, (water pill), for it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-11-06
Call successful
Other
2022-02-15
Survey response — 12 months, dose 2
MedDRA: Cardiac failure congestive — Feeling: Fair

Free text: Congested heart failure

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-16	Moderna
2	2021-02-15	Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-17

Systemic reaction (other): Felt feverish, temp was only 97.3

2021-01-21

Systemic reaction (other): This morning when I got up about 6am I was having trouble breathing. This was like my CHF problem I have been having the past 10 months. I took my mastic and other meds and by noon I felt better. The rest of the d

2021-01-22

Systemic reaction (other): Tiredness

Release 2 — day 7, dose 1

2021-01-23

Systemic reaction (other): Breathing

Release 3 — day 21, dose 1

2021-02-06

Symptoms: Friday morning I felt feverish, but had no fever. For the last 5 days I would start coughing for about 3-5 minutes, felt like a throat irritation, then it would go away, but it keeps coming back about 2 or 3 times a day.

Release 4 — day 28, dose 1

2021-02-13

Symptoms: I am on Lasic for CHF and breathing problems. This week the systems were more pronounced in the evenings. But I would feel better after taking the lasic pill. I have had this CHF since April.

Release 4 — days 1–6 daily, dose 2

2021-02-20

Systemic reaction (other): On Thursday I had a feverish feeling but no temp. Also my joints were aching and I felt bad

2021-02-21

Systemic reaction (other): Dizziness after sitting, unbalancing feeling, usually Waite a few seconds or move slower.

Release 4 — day 7, dose 2

2021-02-23

Systemic reaction (other): Tiredness, took a nap which lasted 3 hours. Very unusual for me.

Release 4 — day 14, dose 2

2021-03-01

Symptoms: On sat I felt a little feverish. But ok now.

Release 5 — day 21, dose 2

2021-03-08

Symptoms: Shortness of breath. Not sure if related to covid shot.

Release 6 — day 35, dose 2

2021-03-22

Symptoms: Low energy, wanting to nap a lot.

Release 6 — day 42, dose 2

2021-03-29

Symptoms: Hard bowel movement.

Release 8 — 3 months, dose 2

2021-05-17

Symptoms: Dizziness, tightness of my chest due I think to my congested heart failure. Im taking Lasic, (water pill), for it.

Release 11 — 12 months, dose 2

2022-02-15

Symptoms: Congested heart failure

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	Adverse reaction	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Cardiac failure congestive	·	·	✓
SD	Chest discomfort	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Somnolence	✓	✓	✓
SD	Throat irritation	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Balance disorder	✓	✓	✓
SRO	Cardiac failure congestive	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pyrexia	✓	✓	✓

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