5GL-10765-73035

2 vaccinations 16 coded responses 25 check-ins 16 free-text entries 5 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 497 / MI
Registered: 2021-02-10

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

2021-02-10
Registered in v-safe
2021-02-10
Dose 1 — Moderna
2021-02-10
Survey response — day 0, dose 1
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: Symptoms due to cancer treatment

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

Adult check-in
2021-02-12
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Good · Fatigue or tiredness

Free text: Symptoms due to chemo treatment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Good · Fatigue or tiredness

Free text: Symptom related to chemo treatment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-16
Survey response — days 1–6 daily, dose 1
MedDRA: Chemotherapy — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Symptoms related to chemo treatment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — day 7, dose 1
MedDRA: Chemotherapy, Pre-existing disease — Feeling: Fair · Fatigue or tiredness

Free text: Symptoms related to chemo treatment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-03-05
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-03-10
Dose 2 — Moderna
2021-03-10
Survey response — day 0, dose 2
MedDRA: Fatigue, Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: Fatigue due to cancer treatment

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

Adult check-in
2021-03-13
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Muscle or body aches, Nausea, Abdominal pain

Free text: Symptoms due to cancer diagnosis/treatment

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: Unevaluable event — Feeling: Poor · Headache, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Unsure if related to chemo treatment or the shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Office visit, Unevaluable event — Feeling: Poor · Headache, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Still unsure if related to injection or cancer treatment · Healthcare visit (other): Appointment with oncologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Poor · Fever · Chills, Headache, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Unsure if related to shot or cancer treatment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — day 7, dose 2
MedDRA: Adverse reaction — Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Symptoms could be related to chemo treatment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — day 14, dose 2
MedDRA: Brain neoplasm, Hospitalisation, Rash — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: New brain tumor and rash on head, hospitalization (most likely due to cancer treatment)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-31
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-09
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-14
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-22
Survey response — day 42, dose 2
MedDRA: Dyspnoea, Headache, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities

Free text: Shortness or breath and headaches, related to cancer diagnosis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-10
Survey response — 3 months, dose 2
MedDRA: Death, Hospice care — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Symptoms: My father (b)(6) passed away May 7, 2021 · Healthcare visit (other): Hospice

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-10
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)
2021-06-17
Call 1 — Left Voicemail
2021-09-08
Survey response — 6 months, dose 2
MedDRA: Death, Hospice care — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Patient passed away 5-7-2021If you have any questions feel free to contact me at this number, I am his daughter. · Healthcare visit (other): Hospice

MedDRA releases: 2024-11 · check-in free text available
2021-09-08
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-09
Call 1 — Left Voicemail
2022-03-10
Survey response — 12 months, dose 2
MedDRA: Death — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Patient passed away May 7, 2021

MedDRA releases: 2024-11 · check-in free text available
2022-03-10
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-03-11
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-10	Moderna
2	2021-03-10	Moderna

Call center

5 call center cases

5 successful

See the call center timeline

Free text

Release 4 — day 0, dose 1

2021-02-10

Systemic reaction (other): Symptoms due to cancer treatment

Release 4 — days 1–6 daily, dose 1

2021-02-12

Systemic reaction (other): Symptoms due to chemo treatment

2021-02-13

Systemic reaction (other): Symptom related to chemo treatment

2021-02-16

Systemic reaction (other): Symptoms related to chemo treatment

Release 4 — day 7, dose 1

2021-02-17

Systemic reaction (other): Symptoms related to chemo treatment

Release 5 — day 0, dose 2

2021-03-10

Systemic reaction (other): Fatigue due to cancer treatment

Release 5 — days 1–6 daily, dose 2

2021-03-13

Systemic reaction (other): Symptoms due to cancer diagnosis/treatment

2021-03-14

Systemic reaction (other): Unsure if related to chemo treatment or the shot

2021-03-15

Systemic reaction (other): Still unsure if related to injection or cancer treatment

Healthcare visit (other): Appointment with oncologist

2021-03-16

Systemic reaction (other): Unsure if related to shot or cancer treatment

Release 5 — day 7, dose 2

2021-03-17

Systemic reaction (other): Symptoms could be related to chemo treatment

Release 6 — day 14, dose 2

2021-03-26

Symptoms: New brain tumor and rash on head, hospitalization (most likely due to cancer treatment)

Release 7 — day 42, dose 2

2021-04-22

Symptoms: Shortness or breath and headaches, related to cancer diagnosis

Release 9 — 3 months, dose 2

Reports this person's death

2021-06-10

Symptoms: My father (b)(6) passed away May 7, 2021

Healthcare visit (other): Hospice

redacted (b)(6)

Release 9 — 6 months, dose 2

Reports this person's death

2021-09-08

Symptoms: Patient passed away 5-7-2021If you have any questions feel free to contact me at this number, I am his daughter.

Healthcare visit (other): Hospice

Release 11 — 12 months, dose 2

Reports this person's death

2022-03-10

Symptoms: Patient passed away May 7, 2021

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	Hospice care	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Brain neoplasm	✓	✓	✓
SD	Death	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rash	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Chemotherapy	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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