5P8-30575-26255

3 vaccinations 9 coded responses 20 check-ins 9 free-text entries 1 call case

Sex: Male
Age at first dose: 61-65
ZIP prefix: 283 / NC
Registered: 2021-03-14

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-12
Dose 1 — Moderna
2021-03-12
Dose 2 — Moderna
2021-03-14
Registered in v-safe
2021-03-14
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain, Dizziness, Emergency care, Headache, Pain, Palpitations, Pyrexia — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Went to ER yesterday..fever..aches..pain chest hurting..hurt to breathe..heart racing..headache..dizziness..arm hurting badaaaa

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-19
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2021-03-27
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2022-03-12
Survey response — 12 months, dose 2
MedDRA: Ear discomfort, Ear disorder, Ear pain, Pulmonary congestion, Respiratory tract congestion, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities

Free text: Ear problem with left ear..feels like something is in it and have sharp pains from time to time..back problem and R knee..some congestion lungs and head..maybe possible sinus infection..

MedDRA releases: 2024-11 · check-in free text available
2022-05-23
Dose 3 — Other-Unknown
2022-05-23
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2022-05-24
Survey response — days 1–6 daily, dose 3
MedDRA: Pre-existing disease — Feeling: Good · Site: Pain · Be unable to do your normal daily activities

Free text: I already have been diagnosed with CRIPS and hyperhydrosis, orthostatic hypotension, type II diabetes, and at risk of skin infections MRSA and fungal infections

MedDRA releases: 2024-11 · check-in free text available
2022-05-25
Survey response — days 1–6 daily, dose 3
MedDRA: Pre-existing disease — Feeling: Fair

Free text: Yes, when I went to Walmart to get my booster administered suppose to have been at 9am there was a mixup and I didn't get my booster till a little before noon I arrived there through Medicaid transportation through NC Medicaid I am type II diabetic

MedDRA releases: 2024-11 · check-in free text available
2022-05-26
Survey response — days 1–6 daily, dose 3
MedDRA: Complex regional pain syndrome, Hyperhidrosis, Type 2 diabetes mellitus — Feeling: Good

Free text: Type II DIABETES, CRIPS(RSD), HYPERHYDROSIS

MedDRA releases: 2024-11 · check-in free text available
2022-05-27
Survey response — days 1–6 daily, dose 3
MedDRA: Blood glucose decreased, Pain, Photophobia, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities

Free text: Light sensitivity, bout of low blood glucose, flare up of CRIPS pain

MedDRA releases: 2024-11 · check-in free text available
2022-05-28
Survey response — days 1–6 daily, dose 3
MedDRA: Hypoaesthesia, Paraesthesia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Paresthesia RT calf and numbness in RT foot

MedDRA releases: 2024-11 · check-in free text available
2022-05-29
Survey response — days 1–6 daily, dose 3
MedDRA: Back pain, Pre-existing disease, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities

Free text: Allergy from environment and back pain and right leg problems

MedDRA releases: 2024-11 · check-in free text available
2022-06-01
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2022-06-06
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-06-13
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-06-20
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-06-27
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-07-04
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-08-22
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-11-21
Survey response — 6 months, dose 3
MedDRA: Feeling of body temperature change, Office visit, Pain, Spinal operation — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: had back surgery for 2nd time.. pain is not good.. running hot cold told wound looks ok...got flu shot now told I need 2nd booster for COVID and just found out my pneumonia shot is past due..also I saw in MY CHART (b)(6)..I need end shingle's zoster sho · Healthcare visit (other): P. OP . with PCP

MedDRA releases: 2024-11 · check-in free text available
2022-11-21
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-22
Call 1 — Could Not Reach Participant
2022-11-22
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-12	Moderna
2	2021-03-12	Moderna
3	2022-05-23	Other-Unknown	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-14

Systemic reaction (other): Went to ER yesterday..fever..aches..pain chest hurting..hurt to breathe..heart racing..headache..dizziness..arm hurting badaaaa

Release 11 — 12 months, dose 2

2022-03-12

Symptoms: Ear problem with left ear..feels like something is in it and have sharp pains from time to time..back problem and R knee..some congestion lungs and head..maybe possible sinus infection..

Release 11 — days 1–6 daily, dose 3

2022-05-24

Systemic reaction (other): I already have been diagnosed with CRIPS and hyperhydrosis, orthostatic hypotension, type II diabetes, and at risk of skin infections MRSA and fungal infections

2022-05-25

Systemic reaction (other): Yes, when I went to Walmart to get my booster administered suppose to have been at 9am there was a mixup and I didn't get my booster till a little before noon I arrived there through Medicaid transportation through NC Medicaid I am type II diabetic cut off by CDC

2022-05-26

Systemic reaction (other): Type II DIABETES, CRIPS(RSD), HYPERHYDROSIS

2022-05-27

Systemic reaction (other): Light sensitivity, bout of low blood glucose, flare up of CRIPS pain

2022-05-28

Systemic reaction (other): Paresthesia RT calf and numbness in RT foot

2022-05-29

Systemic reaction (other): Allergy from environment and back pain and right leg problems

Release 12 — 6 months, dose 3

2022-11-21

Symptoms: had back surgery for 2nd time.. pain is not good.. running hot cold told wound looks ok...got flu shot now told I need 2nd booster for COVID and just found out my pneumonia shot is past due..also I saw in MY CHART (b)(6)..I need end shingle's zoster sho cut off by CDC

Healthcare visit (other): P. OP . with PCP

redacted (b)(6)

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	·	·	✓
SD	Ear discomfort	·	·	✓
SD	Ear disorder	·	·	✓
SD	Ear pain	·	·	✓
SD	Feeling of body temperature change	·	·	✓
SD	Pain	·	·	✓
SD	Pulmonary congestion	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Spinal operation	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Back pain	·	·	✓
SRO	Blood glucose decreased	·	·	✓
SRO	Chest pain	✓	✓	✓
SRO	Complex regional pain syndrome	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Emergency care	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Hyperhidrosis	·	·	✓
SRO	Hypoaesthesia	·	·	✓
SRO	Pain	✓	✓	✓
SRO	Palpitations	✓	✓	✓
SRO	Paraesthesia	·	·	✓
SRO	Photophobia	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Pyrexia	✓	✓	✓
SRO	Type 2 diabetes mellitus	·	·	✓
SRO	Unevaluable event	·	·	✓

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