4VV-16732-82515

5 vaccinations 12 coded responses 33 check-ins 11 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 981 / WA
Registered: 2021-04-06

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

2021-03-03
Dose 1 — Moderna
2021-04-03
Dose 2 — Moderna
2021-04-06
Registered in v-safe
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-08
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Joint pains

Free text: Dose 1 date should be March 6, 2021.

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

Adult check-in
2021-04-10
Survey response — day 7, dose 2
MedDRA: Pyrexia — Feeling: Good · Fever · Headache, Joint pains, Fatigue or tiredness

Free text: Feverish but know temperature is normal

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Survey response — day 14, dose 2
MedDRA: Fatigue — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Persistent Fatigue. Starts about midday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-08
Survey response — day 35, dose 2
MedDRA: Fatigue — Feeling: Good · Be unable to do your normal daily activities

Free text: Not sure if this is related to the vaccine. This past week I have been easily fatigued. I have to struggle to stay awake. Even minor labor or short walks tire me requiring a rest period.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-03
Survey response — 3 months, dose 2
MedDRA: Back pain, Blood potassium decreased, Confusional state, Headache, Neck pain — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Pain in neck. Persistent headaches back pain. Low potassium. A day of confusion.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-03
Report sent to call center — 3 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-08
Call 1 — Left Voicemail
2021-10-06
Survey response — 6 months, dose 2
MedDRA: Face injury, Fall, Hypokalaemia — Feeling: Good

Free text: Hypkalemia Fall with facial injuries.

MedDRA releases: 2024-11 · check-in free text available
2022-02-03
Dose 3 — Moderna
2022-04-03
Health check-in — 12 months, dose 2
Feeling: Good

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

Adult check-in
2022-06-10
Dose 4 — Moderna
2022-06-12
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Joint pains, Fatigue or tiredness

Adult check-in
2022-06-13
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-06-14
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Joint pains, Muscle or body aches

Adult check-in
2022-06-15
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Joint pains, Muscle or body aches

Adult check-in
2022-06-16
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Joint pains, Muscle or body aches

Adult check-in
2022-06-17
Health check-in — day 7, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2022-06-24
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-07-02
Survey response — day 21, dose 4
MedDRA: Arthralgia, Arthropathy, Joint noise — Feeling: Fair

Free text: Knee pain with grinding and weakness

MedDRA releases: 2024-11 · check-in free text available
2022-07-09
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-07-16
Survey response — day 35, dose 4
MedDRA: Fatigue, Pain, Pre-existing disease — Feeling: Fair

Free text: Chronic knee and hip pain has increased. Also an increase in general tiredness.

MedDRA releases: 2024-11 · check-in free text available
2022-07-22
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-09-09
Survey response — 3 months, dose 4
MedDRA: Prostatic specific antigen increased — Feeling: Fair

Free text: Elevated PSA.

MedDRA releases: 2024-11 · check-in free text available
2022-11-22
Dose 5 — Moderna
2022-12-09
Survey response — day 14, dose 5
MedDRA: Diarrhoea, Nausea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Diarrhea nausea no fever

MedDRA releases: 2024-11 · check-in free text available
2022-12-09
Survey response — 6 months, dose 4
MedDRA: Diarrhoea, Nausea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Diarhea with nausea no fever

MedDRA releases: 2024-11 · check-in free text available
2022-12-14
Health check-in — day 21, dose 5
Feeling: Fair

Adult check-in
2022-12-20
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-12-27
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2023-01-04
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2023-02-21
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-05-23
Survey response — 6 months, dose 5
MedDRA: COVID-19, Cough, Penile haemorrhage, Penile pain — Feeling: Poor · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-03	Moderna
2	2021-04-03	Moderna
3	2022-02-03	Moderna	No
4	2022-06-10	Moderna	No
5	2022-11-22	Moderna	No

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-08

Systemic reaction (other): Dose 1 date should be March 6, 2021.

Release 7 — day 7, dose 2

2021-04-10

Systemic reaction (other): Feverish but know temperature is normal

Release 7 — day 14, dose 2

2021-04-17

Symptoms: Persistent Fatigue. Starts about midday.

Release 8 — day 35, dose 2

2021-05-08

Symptoms: Not sure if this is related to the vaccine. This past week I have been easily fatigued. I have to struggle to stay awake. Even minor labor or short walks tire me requiring a rest period.

Release 9 — 3 months, dose 2

2021-07-03

Symptoms: Pain in neck. Persistent headaches back pain. Low potassium. A day of confusion.

Release 10 — 6 months, dose 2

2021-10-06

Symptoms: Hypkalemia Fall with facial injuries.

Release 12 — day 21, dose 4

2022-07-02

Symptoms: Knee pain with grinding and weakness

Release 12 — day 35, dose 4

2022-07-16

Symptoms: Chronic knee and hip pain has increased. Also an increase in general tiredness.

Release 12 — 3 months, dose 4

2022-09-09

Symptoms: Elevated PSA.

Release 12 — day 14, dose 5

2022-12-09

Symptoms: Diarrhea nausea no fever

Release 12 — 6 months, dose 4

2022-12-09

Symptoms: Diarhea with nausea no fever

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	Arthralgia	·	·	✓
SD	Arthropathy	·	·	✓
SD	Back pain	✓	✓	✓
SD	Blood potassium decreased	✓	✓	✓
SD	Confusional state	✓	✓	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Face injury	·	·	✓
SD	Fall	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypokalaemia	·	·	✓
SD	Joint noise	·	·	✓
SD	Nausea	·	·	✓
SD	Neck pain	✓	✓	✓
SD	Pain	·	·	✓
SD	Penile haemorrhage	·	·	✓
SD	Penile pain	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Prostatic specific antigen increased	·	·	✓
SRO	Pyrexia	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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