5LL-30490-74297

2 vaccinations 6 coded responses 11 check-ins 6 free-text entries 2 call cases

Sex: Male
Age at first dose: 36-40
ZIP prefix: 068 / CT
Registered: 2021-04-28

Relationship: Self
Race: N/A
Ethnicity: N/A

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-21
Dose 1 — Moderna
2021-04-28
Registered in v-safe
2021-04-28
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-05-15
Survey response — day 21, dose 1
MedDRA: Injection site pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: My right shoulder (injection site) continues to be very painful.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Dose 2 — Moderna
2021-05-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling · Headache

Adult check-in
2021-05-23
Survey response — days 1–6 daily, dose 2
MedDRA: Condition aggravated, Pre-existing disease, Swelling, Unevaluable event — Feeling: Fair · Site: Pain, Redness, Swelling · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): I continue to be experiencing an increase in swelling of areas which are related to chronic Veinous issues. This condition began in early April 2020, and has had a noticeable increase since being administered first dose · Healthcare visit (other): I will be contacting my Vascular Specialist for treatment tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-24
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site swelling, Swelling — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Continue to experience swelling at injection site as well as throughout lower half of body

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-26
Survey response — day 7, dose 2
MedDRA: Peripheral swelling — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Continued swelling of lower extremities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-03
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-06-09
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-06-16
Survey response — day 28, dose 2
MedDRA: Arthralgia, Lymphadenopathy, Office visit, Pain, Pre-existing disease, Vein disorder — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: My right shoulder has never improved, and in recent days has actually become worse. Additionally, the flare up of my veinous/lymphatic condition, since vaccination, has not changed. · Healthcare visit (other): Saw my pcp on 5/30, he placed me on a diuretic to reduce some of the fluid weight I was carrying . He also ordered echocardiogram. Hecc be anal referred me to physical therapy for shoulder.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-16
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-21
Call 1 — Left Voicemail
2021-06-24
Survey response — day 35, dose 2
MedDRA: Swelling — Feeling: Fair · Be unable to do your normal daily activities

Free text: The swelling of my lower half relating to vascular issue was worse this past week.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-24
Call 2 — Left Voicemail
2021-11-17
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-21	Moderna
2	2021-05-19	Moderna

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 8 — day 21, dose 1

2021-05-15

Symptoms: My right shoulder (injection site) continues to be very painful.

Release 8 — days 1–6 daily, dose 2

2021-05-23

Systemic reaction (other): I continue to be experiencing an increase in swelling of areas which are related to chronic Veinous issues. This condition began in early April 2020, and has had a noticeable increase since being administered first dose

Healthcare visit (other): I will be contacting my Vascular Specialist for treatment tomorrow

2021-05-24

Systemic reaction (other): Continue to experience swelling at injection site as well as throughout lower half of body

Release 8 — day 7, dose 2

2021-05-26

Systemic reaction (other): Continued swelling of lower extremities

Release 9 — day 28, dose 2

2021-06-16

Symptoms: My right shoulder has never improved, and in recent days has actually become worse. Additionally, the flare up of my veinous/lymphatic condition, since vaccination, has not changed.

Healthcare visit (other): Saw my pcp on 5/30, he placed me on a diuretic to reduce some of the fluid weight I was carrying . He also ordered echocardiogram. Hecc be anal referred me to physical therapy for shoulder.

Release 9 — day 35, dose 2

2021-06-24

Symptoms: The swelling of my lower half relating to vascular issue was worse this past week.

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	Office visit	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Lymphadenopathy	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Swelling	✓	✓	✓
SD	Vein disorder	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Injection site swelling	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Swelling	✓	✓	✓

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