5P4-14205-79451

2 vaccinations 7 coded responses 26 check-ins 7 free-text entries 1 call case

Sex: Male
Age at first dose: 61-65
ZIP prefix: 864 / AZ
Registered: 2021-02-17

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

2021-02-17
Registered in v-safe
2021-02-17
Dose 1 — Moderna
2021-02-17
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-19
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-22
Survey response — days 1–6 daily, dose 1
MedDRA: Eye disorder — Feeling: Good

Free text: My eyes blackened a bit the two days after the shot. I forgot to put it in.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-10
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-17
Dose 2 — Moderna
2021-03-17
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-19
Survey response — days 1–6 daily, dose 2
MedDRA: Bone pain — Feeling: Poor · Site: Pain, Redness, Swelling · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Sharp bone pain at random locations

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling abnormal, Mydriasis, Pain in extremity — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: My right foot and left leg had pain like a needle was in the bone. It didnt last but a couple hours. My eyes turned black like I got hit by a baseball bat. Did not affect my vision. Foggy headed.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Survey response — days 1–6 daily, dose 2
MedDRA: Eye colour change — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: My eyes are still black.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Muscle or body aches

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Joint pains, Muscle or body aches

Adult check-in
2021-03-24
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-03-31
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-21
Survey response — day 35, dose 2
MedDRA: Anxiety, Confusional state, Depression — Feeling: Fair · Be unable to do your normal daily activities

Free text: Depression and anxiety, occasionally confusion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-16
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-15
Survey response — 6 months, dose 2
MedDRA: Cough, Nasal congestion, Nasopharyngitis — Feeling: Fair · Be unable to do your normal daily activities

Free text: Stuffy nose, coughing, like a cold

MedDRA releases: 2024-11 · check-in free text available
2022-03-19
Survey response — 12 months, dose 2
MedDRA: Back disorder, Bronchitis, COVID-19, Gait disturbance — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Bronchitis, and caught Covid. Back went out so I can barely walk.

MedDRA releases: 2024-11 · check-in free text available
2022-03-19
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-22
Call 1 — Left Voicemail
2022-03-22
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-17	Moderna
2	2021-03-17	Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-22

Systemic reaction (other): My eyes blackened a bit the two days after the shot. I forgot to put it in.

Release 5 — days 1–6 daily, dose 2

2021-03-19

Systemic reaction (other): Sharp bone pain at random locations

Release 6 — days 1–6 daily, dose 2

2021-03-20

Systemic reaction (other): My right foot and left leg had pain like a needle was in the bone. It didnt last but a couple hours. My eyes turned black like I got hit by a baseball bat. Did not affect my vision. Foggy headed.

2021-03-21

Systemic reaction (other): My eyes are still black.

Release 7 — day 35, dose 2

2021-04-21

Symptoms: Depression and anxiety, occasionally confusion

Release 9 — 6 months, dose 2

2021-09-15

Symptoms: Stuffy nose, coughing, like a cold

Release 11 — 12 months, dose 2

2022-03-19

Symptoms: Bronchitis, and caught Covid. Back went out so I can barely walk.

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	Anxiety	✓	✓	✓
SD	Back disorder	·	·	✓
SD	Bronchitis	·	·	✓
SD	Confusional state	✓	✓	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Depression	✓	✓	✓
SD	Gait disturbance	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	·	·	✓
SRO	Bone pain	✓	✓	✓
SRO	Eye colour change	✓	✓	✓
SRO	Eye disorder	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Mydriasis	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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