598-32435-48898

2 vaccinations 12 coded responses 25 check-ins 12 free-text entries 1 call case

Sex: —
Age at first dose: 66+
ZIP prefix: 960 / CA
Registered: 2021-02-14

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

2021-02-13
Dose 1 — Moderna
2021-02-14
Registered in v-safe
2021-02-14
Survey response — days 1–6 daily, dose 1
MedDRA: Hypersomnia — Feeling: Good · Site: Pain

Free text: Just sleeping a lot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Fair · Muscle or body aches

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good

Free text: No Doing good

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Fair · Headache, Muscle or body aches

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — days 1–6 daily, dose 1
MedDRA: Nasopharyngitis — Feeling: Fair · Headache, Muscle or body aches

Free text: Probably a little head cold

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-22
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-27
Survey response — day 14, dose 1
MedDRA: Fatigue, Myalgia, SARS-CoV-2 test — Feeling: Poor

Free text: Fatigue, muscle pain-covid test on 3/1/21On3/4/21 heart thing(Cathetet Ablation)Stopped heart medication. Could be whyI feel the way I do

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-13
Dose 2 — Moderna
2021-03-13
Survey response — day 0, dose 2
MedDRA: Injection site haemorrhage — Feeling: Fair · Fatigue or tiredness

Free text: A lot of blood when they pulled the needle out. It' s never happened before for any vacination. Right now it seems to ne ok

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-03-19
Survey response — days 1–6 daily, dose 2
MedDRA: Constipation, Feeling abnormal — Feeling: Fair · Fever · Muscle or body aches, Abdominal pain

Free text: A little constapation/ a little yukki , but over all noy bad

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — day 7, dose 2
Feeling: Good · Headache

Adult check-in
2021-03-27
Survey response — day 14, dose 2
MedDRA: Injection site haemorrhage, Injection site pain — Feeling: Good

Free text: Today where I got the shot a little soreNobody has explained why blood squirted the way it did-I'm not on blood thinner

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

Adult check-in
2021-04-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-18
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-25
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-13
Survey response — 3 months, dose 2
MedDRA: Dyspepsia — Feeling: Good

Free text: Having a lot more heartburn then beforeMy wife and. Sister also had more heartburn. My wife died 04/17, had nothing to do with covid. Broken hip and appatent blood cloy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-11
Survey response — 6 months, dose 2
MedDRA: Body temperature fluctuation, Breath odour, Nasal congestion, SARS-CoV-2 test negative — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: 08/02/21 had temp of 101. At 9:30 by 1pm it was 97.4. Volunteered for covid, test. The nurse was pissed at me for earlier stuff and tried to break my nose. It was clogged for long still doesn't feel right. The test was negative. Had a few bad breathi

MedDRA releases: 2024-11 · check-in free text available
2021-09-11
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-03-15
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-13	Moderna
2	2021-03-13	Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-14

Systemic reaction (other): Just sleeping a lot

2021-02-15

Systemic reaction (other): No

2021-02-16

Systemic reaction (other): No Doing good

2021-02-17

Systemic reaction (other): No

2021-02-18

Systemic reaction (other): Probably a little head cold

Release 4 — day 14, dose 1

2021-02-27

Symptoms: Fatigue, muscle pain-covid test on 3/1/21On3/4/21 heart thing(Cathetet Ablation)Stopped heart medication. Could be whyI feel the way I do

Release 5 — day 0, dose 2

2021-03-13

Systemic reaction (other): A lot of blood when they pulled the needle out. It' s never happened before for any vacination. Right now it seems to ne ok

Release 5 — days 1–6 daily, dose 2

2021-03-14

Systemic reaction (other): No

2021-03-19

Systemic reaction (other): A little constapation/ a little yukki , but over all noy bad

Release 6 — day 14, dose 2

2021-03-27

Symptoms: Today where I got the shot a little soreNobody has explained why blood squirted the way it did-I'm not on blood thinner

Release 9 — 3 months, dose 2

2021-06-13

Symptoms: Having a lot more heartburn then beforeMy wife and. Sister also had more heartburn. My wife died 04/17, had nothing to do with covid. Broken hip and appatent blood cloy

Release 9 — 6 months, dose 2

2021-09-11

Symptoms: 08/02/21 had temp of 101. At 9:30 by 1pm it was 97.4. Volunteered for covid, test. The nurse was pissed at me for earlier stuff and tried to break my nose. It was clogged for long still doesn't feel right. The test was negative. Had a few bad breathi cut off by CDC

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 fluctuation	·	·	✓
SD	Breath odour	·	·	✓
SD	Dyspepsia	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Injection site haemorrhage	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	SARS-CoV-2 test	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Constipation	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Hypersomnia	✓	✓	✓
SRO	Injection site haemorrhage	✓	✓	✓
SRO	Nasopharyngitis	✓	✓	✓
SRO	No adverse event	✓	✓	✓

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