56P-11659-08073

5 vaccinations 10 coded responses 40 check-ins 9 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 100 / NY
Registered: 2021-01-20

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

2021-01-20
Registered in v-safe
2021-01-20
Dose 1 — Moderna
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fever · Chills

Adult check-in
2021-01-24
Survey response — days 1–6 daily, dose 1
MedDRA: Chills, Pyrexia — Feeling: Good

Free text: I received my Moderna dose on 1/20. After 24 hours I had chills and fever that spiked to 100.8 f. I mention this because I missed the first questionnaire.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · Chills

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — day 7, dose 1
Feeling: Good · Headache

Adult check-in
2021-02-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-10
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-17
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-18
Dose 2 — Moderna
2021-02-18
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fever · Headache

Adult check-in
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Pyrexia — Feeling: Good · Site: Pain · Fever · Chills, Headache

Free text: I normally have about 97.9f in the morning so 99.0, while not hi fever is unusual for me

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Joint pains, Abdominal pain

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-23
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Fever · Abdominal pain

Free text: Normal temperature for me is 97.8f in AM, and 98.2f in PM

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — day 7, dose 2
Feeling: Good · Fever · Abdominal pain

Adult check-in
2021-03-04
Survey response — day 14, dose 2
MedDRA: Unevaluable event — Feeling: Good

Free text: My temperature went up one evening to 99.3f, but went down to my usual AM temperature of 97.8f the next morning.

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

Free text: Chills lasting a few hours

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — day 28, dose 2
MedDRA: Unevaluable event — Feeling: Good

Free text: A brief bout of a few hours of 99.5 fever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-20
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-21
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-21
Dose 3 — Moderna
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Chills, Muscle or body aches

Adult check-in
2021-10-28
Health check-in — day 7, dose 3
Feeling: Good · Site: Itching · Chills, Muscle or body aches

Adult check-in
2021-11-04
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-11
Survey response — day 21, dose 3
MedDRA: Hypotension — Feeling: Good

Free text: Low blood pressure

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Survey response — day 28, dose 3
MedDRA: Dizziness — Feeling: Fair

Free text: Feelings of faintness. Possibly relating to anti hypertensive medication rather than vaccine

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-02
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-20
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-21
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-05-05
Dose 4 — Pfizer-BioNTech
2022-10-06
Dose 5 — Moderna
Co-administered: Flu
2022-10-13
Health check-in — day 7, dose 5
Feeling: Good · Muscle or body aches

Adult check-in
2022-10-20
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-27
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-04
Survey response — day 28, dose 5
MedDRA: Body temperature increased, Chills, Headache, Malaise, SARS-CoV-2 test positive, Sneezing — Feeling: Fair · Be unable to do your normal daily activities

Free text: I tested positive for coronavirus. I'm on Paxlovid. I felt not too good yesterday but ok today: some sneezing, headache, 100.3f fever, chills. I think I'm gradually improving.

MedDRA releases: 2024-11 · check-in free text available
2022-11-10
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-17
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-05
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-04-06
Survey response — 6 months, dose 5
MedDRA: Chills, Dysuria — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-06
Report sent to call center — 6 months, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-07
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-20	Moderna
2	2021-02-18	Moderna
3	2021-10-21	Moderna	No
4	2022-05-05	Pfizer-BioNTech	No
5	2022-10-06	Moderna	Flu

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-24

Systemic reaction (other): I received my Moderna dose on 1/20. After 24 hours I had chills and fever that spiked to 100.8 f. I mention this because I missed the first questionnaire.

Release 4 — days 1–6 daily, dose 2

2021-02-20

Systemic reaction (other): I normally have about 97.9f in the morning so 99.0, while not hi fever is unusual for me

2021-02-23

Systemic reaction (other): Normal temperature for me is 97.8f in AM, and 98.2f in PM

Release 5 — day 14, dose 2

2021-03-04

Symptoms: My temperature went up one evening to 99.3f, but went down to my usual AM temperature of 97.8f the next morning.

Release 5 — day 21, dose 2

2021-03-11

Symptoms: Chills lasting a few hours

Release 5 — day 28, dose 2

2021-03-18

Symptoms: A brief bout of a few hours of 99.5 fever

Release 10 — day 21, dose 3

2021-11-11

Symptoms: Low blood pressure

Release 10 — day 28, dose 3

2021-11-18

Symptoms: Feelings of faintness. Possibly relating to anti hypertensive medication rather than vaccine

Release 12 — day 28, dose 5

2022-11-04

Symptoms: I tested positive for coronavirus. I'm on Paxlovid. I felt not too good yesterday but ok today: some sneezing, headache, 100.3f fever, chills. I think I'm gradually improving.

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	Body temperature increased	·	·	✓
SD	Chills	✓	✓	✓
SD	Dizziness	·	·	✓
SD	Dysuria	·	·	✓
SD	Headache	·	·	✓
SD	Hypotension	·	·	✓
SD	Malaise	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sneezing	·	·	✓
SD	Unevaluable event	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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