4YW-17777-59158

2 vaccinations 10 coded responses 23 check-ins 10 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 539 / WI
Registered: 2021-02-04

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

2021-02-03
Dose 1 — Moderna
2021-02-04
Registered in v-safe
2021-02-04
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite, Dizziness — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Decreased appetite, dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Good · Site: Pain · Headache

Free text: Slight dizziness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-17
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-24
Survey response — day 21, dose 1
MedDRA: Feeling abnormal — Feeling: Good

Free text: Foggy feeling in mind& not remembering like i used to.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Dose 2 — Moderna
2021-03-03
Survey response — day 0, dose 2
MedDRA: Dizziness — Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Free text: Dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Light headed & dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder — Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Free text: Balance

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-03-10
Survey response — day 7, dose 2
MedDRA: Respiratory tract congestion — Feeling: Good · Headache, Joint pains, Fatigue or tiredness

Free text: Cognition

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-24
Survey response — day 21, dose 2
MedDRA: Office visit, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: I have not reported this before but i have had a continuous problem with A-Fib beginning when i got covid. Please call if you would like more information. (b)(6) · Healthcare visit (other): Clinic apt. With cardiologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-02
Survey response — 3 months, dose 2
MedDRA: Arrhythmia, Atrial fibrillation, Hospitalisation — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: I have been in A-Fib since having covid. Im in hospital 3 days to try to get my heart in normal rhythm. My cardiologist has tried several other things hopefully this going to work.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-01
Call 1 — Left Voicemail
2021-11-02
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-03-03
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-03	Moderna
2	2021-03-03	Moderna

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 3 — days 1–6 daily, dose 1

2021-02-04

Systemic reaction (other): Decreased appetite, dizziness

2021-02-05

Systemic reaction (other): Dizziness

2021-02-06

Systemic reaction (other): Slight dizziness.

Release 4 — day 21, dose 1

2021-02-24

Symptoms: Foggy feeling in mind& not remembering like i used to.

Release 5 — day 0, dose 2

2021-03-03

Systemic reaction (other): Dizzy

Release 5 — days 1–6 daily, dose 2

2021-03-04

Systemic reaction (other): Light headed & dizzy

2021-03-05

Systemic reaction (other): Balance

Release 5 — day 7, dose 2

2021-03-10

Systemic reaction (other): Cognition

Release 6 — day 21, dose 2

2021-03-24

Symptoms: I have not reported this before but i have had a continuous problem with A-Fib beginning when i got covid. Please call if you would like more information. (b)(6)

Healthcare visit (other): Clinic apt. With cardiologist.

redacted (b)(6)

Release 8 — 3 months, dose 2

2021-06-02

Symptoms: I have been in A-Fib since having covid. Im in hospital 3 days to try to get my heart in normal rhythm. My cardiologist has tried several other things hopefully this going to work.

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	Office visit	✓	✓	✓
SD	Arrhythmia	✓	✓	✓
SD	Atrial fibrillation	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Unevaluable event	✓	✓	✓
SRO	Balance disorder	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓

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