56C-28615-30203

4 vaccinations 10 coded responses 26 check-ins 9 free-text entries 0 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 957 / CA
Registered: 2021-01-04

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

2020-12-28
Dose 1 — Moderna
2021-01-04
Registered in v-safe
2021-01-04
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-13
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-20
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-25
Dose 2 — Moderna
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness, Nausea, Vomiting · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-28
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Throat/neck area

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-31
Survey response — days 1–6 daily, dose 2
MedDRA: Depressed mood, Dizziness, Fatigue — Feeling: Fair · Headache · Be unable to work, Be unable to do your normal daily activities

Free text: Dizzy spell, Depressed & Exhausted

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Survey response — day 7, dose 2
MedDRA: Depression, Dizziness — Feeling: Fair · Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Dizzy spell, Depression (no reason)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-15
Survey response — day 21, dose 2
MedDRA: Confusional state, Depression — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Depression & confusions are getting awfully worse and worse each day. Dunno why. Never experienced such things in my whole life. Scary. Wait and see.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — day 28, dose 2
MedDRA: Confusional state, Depression — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Depression & confusion.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Survey response — day 35, dose 2
MedDRA: Anxiety, Confusional state, Depression — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Depression, Anxiety and confusion worsen.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-26
Survey response — 3 months, dose 2
MedDRA: Depression, Fatigue, Mental disorder — Feeling: Good · Be unable to do your normal daily activities

Free text: Depression & Exhaustion including mental issues have increased at some times but most of time have been fine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-26
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-28
Dose 3 — Moderna
2022-01-25
Survey response — 12 months, dose 2
MedDRA: Anxiety, Asthenia, Depression, Feeling of despair, Insomnia, Joint noise — Feeling: Fair · Be unable to do your normal daily activities

Free text: There is a few symposium-related issues here. (Physical): Have been feeling weak, less energy and reduced sleep hours. Also, my jaws has been "snapping" each time I chew. Mentality): Have been feeling hopeless,, depression, constant worrisome.

MedDRA releases: 2024-11 · check-in free text available
2022-02-27
Survey response — 3 months, dose 3
MedDRA: Abdominal pain upper, Asthenia, Confusional state, Depressed mood, Feeling abnormal — Feeling: Fair · Be unable to do your normal daily activities

Free text: It started a few days ago. Dislike these awful feelings. Don't know what they are because I haven't seen any DR yet $$$$I have been feeling very weak, confused, bad stomachaches, and depressed. Hmm perhaps wait a few more days or so?

MedDRA releases: 2024-11 · check-in free text available
2022-04-09
Dose 4 — Moderna
2022-04-16
Health check-in — day 7, dose 4
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Diarrhea

Adult check-in
2022-04-23
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-02
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-08
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-11
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-08
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-09
Survey response — 12 months, dose 4
MedDRA: Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-28	Moderna
2	2021-01-25	Moderna
3	2021-11-28	Moderna	No
4	2022-04-09	Moderna	No

Free text

Release 2 — days 1–6 daily, dose 2

2021-01-28

Systemic reaction (other): Throat/neck area

Release 3 — days 1–6 daily, dose 2

2021-01-31

Systemic reaction (other): Dizzy spell, Depressed & Exhausted

Release 3 — day 7, dose 2

2021-02-01

Systemic reaction (other): Dizzy spell, Depression (no reason)

Release 4 — day 21, dose 2

2021-02-15

Symptoms: Depression & confusions are getting awfully worse and worse each day. Dunno why. Never experienced such things in my whole life. Scary. Wait and see.

Release 4 — day 28, dose 2

2021-02-22

Symptoms: Depression & confusion.

Release 4 — day 35, dose 2

2021-03-01

Symptoms: Depression, Anxiety and confusion worsen.

Release 8 — 3 months, dose 2

2021-04-26

Symptoms: Depression & Exhaustion including mental issues have increased at some times but most of time have been fine.

Release 11 — 12 months, dose 2

2022-01-25

Symptoms: There is a few symposium-related issues here. (Physical): Have been feeling weak, less energy and reduced sleep hours. Also, my jaws has been "snapping" each time I chew. Mentality): Have been feeling hopeless,, depression, constant worrisome.

Release 11 — 3 months, dose 3

2022-02-27

Symptoms: It started a few days ago. Dislike these awful feelings. Don't know what they are because I haven't seen any DR yet $$$$I have been feeling very weak, confused, bad stomachaches, and depressed. Hmm perhaps wait a few more days or so?

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	Anxiety	✓	✓	✓
SD	Asthenia	·	·	✓
SD	Confusional state	✓	✓	✓
SD	Depressed mood	·	·	✓
SD	Depression	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	·	·	✓
SD	Feeling of despair	·	·	✓
SD	Insomnia	·	·	✓
SD	Joint noise	·	·	✓
SD	Mental disorder	✓	✓	✓
SD	Unevaluable event	·	·	✓
SRO	Depressed mood	✓	✓	✓
SRO	Depression	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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