57Z-20251-46843

4 vaccinations 5 coded responses 41 check-ins 4 free-text entries 0 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 626 / IL
Registered: 2021-05-18

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

2021-04-20
Dose 1 — Moderna
2021-05-18
Registered in v-safe
2021-05-18
Dose 2 — Moderna
2021-05-18
Health check-in — day 0, dose 2
Feeling: Poor · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-05-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-25
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-06-01
Survey response — day 14, dose 2
MedDRA: Condition aggravated, Cough, Fatigue, Pre-existing disease, Upper respiratory tract infection — Feeling: Good

Free text: I suffer from CFS, it has taken longer to recover from the fatigue and cognitive decline associated with it. Since the second shot it has effected me more than expected with my condition. I have also developed a cough and upper respiratory congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-08
Survey response — day 21, dose 2
MedDRA: Abdominal discomfort, Cough, Respiratory tract congestion, Sinus congestion — Feeling: Fair

Free text: Coughing and chest and sinus congestion, stomach and bowl irritation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-15
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-22
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-29
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-11-16
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-04-19
Dose 3 — Pfizer-BioNTech
Co-administered: Shingles
2022-04-19
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Fatigue or tiredness, Nausea

Adult check-in
2022-04-20
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2022-04-21
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-23
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2022-04-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2022-04-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Muscle or body aches

Adult check-in
2022-04-26
Health check-in — day 7, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-05-03
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-05-10
Survey response — day 21, dose 3
MedDRA: Balance disorder, Fatigue, Feeling abnormal, Nausea, Pain, Pyrexia, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities

Free text: Low grade fever, nausea, fatigue, ague, and body pain. Felt very poorly for two days before things got a little better for an additional 2 days. I now feel unbalanced but better. My Dr. recently changed my med dosages and added a statin.

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-05-31
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-07-19
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-10-18
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-19
Dose 4 — Pfizer-BioNTech
Co-administered: Flu
2022-10-19
Health check-in — day 0, dose 4
Feeling: Fair · Site: Pain · Muscle or body aches, Nausea

Adult check-in
2022-10-20
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2022-10-21
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2022-10-22
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-10-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-10-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-26
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-11-02
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-09
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-16
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-23
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-30
Survey response — day 42, dose 4
MedDRA: Cough, Fatigue, Headache, Sinus congestion, Sneezing — Feeling: Poor

Free text: Sinus congestion,,headache, coughing, sneezing, and fatigue.

MedDRA releases: 2024-11 · check-in free text available
2023-01-18
Survey response — 3 months, dose 4
MedDRA: Cough, Fatigue, Headache, Respiratory tract congestion — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-04-19
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-20	Moderna
2	2021-05-18	Moderna
3	2022-04-19	Pfizer-BioNTech	Shingles
4	2022-10-19	Pfizer-BioNTech	Flu

Free text

Release 8 — day 14, dose 2

2021-06-01

Symptoms: I suffer from CFS, it has taken longer to recover from the fatigue and cognitive decline associated with it. Since the second shot it has effected me more than expected with my condition. I have also developed a cough and upper respiratory congestion cut off by CDC

Release 8 — day 21, dose 2

2021-06-08

Symptoms: Coughing and chest and sinus congestion, stomach and bowl irritation

Release 11 — day 21, dose 3

2022-05-10

Symptoms: Low grade fever, nausea, fatigue, ague, and body pain. Felt very poorly for two days before things got a little better for an additional 2 days. I now feel unbalanced but better. My Dr. recently changed my med dosages and added a statin.

Release 12 — day 42, dose 4

2022-11-30

Symptoms: Sinus congestion,,headache, coughing, sneezing, and fatigue.

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 discomfort	✓	✓	✓
SD	Balance disorder	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	·	·	✓
SD	Headache	·	·	✓
SD	Nausea	·	·	✓
SD	Pain	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Sinus congestion	✓	✓	✓
SD	Sneezing	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Upper respiratory tract infection	✓	✓	✓

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