5HN-17990-56628

3 vaccinations 6 coded responses 36 check-ins 6 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 626 / IL
Registered: 2021-01-19

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

2021-01-19
Registered in v-safe
2021-01-19
Dose 1 — Moderna
2021-01-19
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — day 7, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-09
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-23
Health check-in — day 35, dose 1
Feeling: Good

Adult check-in
2021-02-28
Dose 2 — Moderna
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

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

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · None

Adult check-in
2021-03-07
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-14
Survey response — day 14, dose 2
MedDRA: Sinus disorder — Feeling: Fair

Free text: Feels like a sinus issue.

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

Adult check-in
2021-03-28
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-04
Survey response — day 35, dose 2
MedDRA: Sinus disorder — Feeling: Fair

Free text: Have had sinus issues for weeks.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Survey response — day 42, dose 2
MedDRA: Hallucination, olfactory, SARS-CoV-2 test negative, Sinus disorder — Feeling: Fair

Free text: Several weeks ago I notice the smell of smoke that wasnt there. It developed over time into sinus issues. My doctor had me take a COVID test that was negative. Antibiotics did not help it. Not sure what it is.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-30
Survey response — 3 months, dose 2
MedDRA: Sinus disorder — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sinus issues.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-30
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-29
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-10-27
Dose 3 — Moderna
2021-10-27
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue, Pain in extremity — Feeling: Good

Free text: I got this booster several weeks ago. I am beyond Ann the issues you have listed. I did have a sore arm and was tired the next day. Otherwise no issues.

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · None

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-03
Health check-in — day 7, dose 3
Feeling: Good · None

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

Adult check-in
2021-11-17
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-24
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-26
Health check-in — 3 months, dose 3
Feeling: Poor

Adult check-in
2022-04-29
Survey response — 6 months, dose 3
MedDRA: Sinus disorder — Feeling: Poor · Be unable to do your normal daily activities

Free text: Sinus issues

MedDRA releases: 2024-11 · check-in free text available
2022-05-12
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-27
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-19	Moderna
2	2021-02-28	Moderna
3	2021-10-27	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — day 14, dose 2

2021-03-14

Symptoms: Feels like a sinus issue.

Release 6 — day 35, dose 2

2021-04-04

Symptoms: Have had sinus issues for weeks.

Release 7 — day 42, dose 2

2021-04-11

Symptoms: Several weeks ago I notice the smell of smoke that wasnt there. It developed over time into sinus issues. My doctor had me take a COVID test that was negative. Antibiotics did not help it. Not sure what it is.

Release 8 — 3 months, dose 2

2021-05-30

Symptoms: Sinus issues.

Release 10 — days 1–6 daily, dose 3

2021-10-28

Systemic reaction (other): I got this booster several weeks ago. I am beyond Ann the issues you have listed. I did have a sore arm and was tired the next day. Otherwise no issues.

Release 11 — 6 months, dose 3

2022-04-29

Symptoms: Sinus issues

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	Hallucination, olfactory	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Sinus disorder	✓	✓	✓
SRO	Fatigue	·	·	✓
SRO	Pain in extremity	·	·	✓

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