4VP-28674-19069

2 vaccinations 7 coded responses 20 check-ins 7 free-text entries 2 call cases

Sex: Male
Age at first dose: 41-45
ZIP prefix: 856 / AZ
Registered: 2021-03-25

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

2021-03-25
Registered in v-safe
2021-03-25
Dose 1 — Moderna
2021-03-25
Survey response — day 0, dose 1
MedDRA: Somnolence — Feeling: Good · Chills, Headache

Free text: I experienced sleepiness & took a nice nap.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-01
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-22
Dose 2 — Moderna
2021-04-22
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Soar throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-29
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-06
Survey response — day 14, dose 2
MedDRA: Dyspnoea — Feeling: Fair

Free text: Shortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-20
Survey response — day 28, dose 2
MedDRA: Dyspnoea, Fatigue, Somnolence — Feeling: Good

Free text: Super sleepy, exhausted, out of breath climbing stairs in the house.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Survey response — day 35, dose 2
MedDRA: Abdominal pain upper, Asthenia, Chills, Diarrhoea, Ear pain, Fatigue, Hallucination, Headache, Oropharyngeal pain, Pain, Pyrexia, Vomiting — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Headaches, stomachache, vomiting, diarrhea, Fever (102.4 +), chills, ears ache, & soar throat. Also have been very weak & exhausted with body aches. Hallucinating & hearing things when fever was high. Symptoms have gone on for past six days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Report sent to call center — day 35, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-03
Survey response — day 42, dose 2
MedDRA: Hospitalisation — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: In the hospital

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-03
Report sent to call center — day 42, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-22
Survey response — 3 months, dose 2
MedDRA: Hypoaesthesia, Pain, Pain in extremity, Paraesthesia — Feeling: Fair

Free text: Body aches. Pains in my legs. Intermittent Tingling feelings & numbness in right arm & hand.

MedDRA releases: 2024-11 · check-in free text available
2021-12-27
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-25	Moderna
2	2021-04-22	Moderna

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 6 — day 0, dose 1

2021-03-25

Systemic reaction (other): I experienced sleepiness & took a nice nap.

Release 7 — days 1–6 daily, dose 2

2021-04-23

Systemic reaction (other): Soar throat

Release 8 — day 14, dose 2

2021-05-06

Symptoms: Shortness of breath

Release 8 — day 28, dose 2

2021-05-20

Symptoms: Super sleepy, exhausted, out of breath climbing stairs in the house.

Release 8 — day 35, dose 2

2021-05-27

Symptoms: Headaches, stomachache, vomiting, diarrhea, Fever (102.4 +), chills, ears ache, & soar throat. Also have been very weak & exhausted with body aches. Hallucinating & hearing things when fever was high. Symptoms have gone on for past six days.

Release 8 — day 42, dose 2

2021-06-03

Symptoms: In the hospital

Release 9 — 3 months, dose 2

2021-07-22

Symptoms: Body aches. Pains in my legs. Intermittent Tingling feelings & numbness in right arm & hand.

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 pain upper	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Ear pain	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Hallucination	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Hypoaesthesia	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	·	·	✓
SD	Paraesthesia	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Somnolence	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Somnolence	✓	✓	✓

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