5PQ-18493-52149

3 vaccinations 10 coded responses 35 check-ins 10 free-text entries 2 call cases

Sex: Male
Age at first dose: 36-40
ZIP prefix: 787 / TX
Registered: 2021-04-22

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

2021-04-22
Registered in v-safe
2021-04-22
Dose 1 — Moderna
2021-04-22
Survey response — day 0, dose 1
MedDRA: Disorientation, Flushing — Feeling: Fair · Headache

Free text: Flushed feeling and mild disorientation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Nausea

Adult check-in
2021-04-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Swelling · None

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-29
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-05-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-13
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-05-20
Dose 2 — Moderna
2021-05-22
Survey response — days 1–6 daily, dose 2
MedDRA: Office visit — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Psychotherapy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-22
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-05-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness

Adult check-in
2021-05-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-05-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-05-27
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-06-03
Survey response — day 14, dose 2
MedDRA: Chest pain, Dyspnoea — Feeling: Poor · Be unable to do your normal daily activities

Free text: Chest pains, difficulty breathing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-10
Survey response — day 21, dose 2
MedDRA: Depression, Dyspnoea, Gastrooesophageal reflux disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Depression, acid reflux, difficulty breathing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-17
Survey response — day 28, dose 2
MedDRA: Obsessive-compulsive disorder — Feeling: Fair · Be unable to do your normal daily activities

Free text: Compulsive behavior

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-24
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-07-01
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-19
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Ear pain, Erythema, Headache, Myalgia, Oropharyngeal pain, Paranasal sinus hypersecretion, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Multiple fevers, extreme apex headache, muscle and joint pain, ear pain and redness, mild sore throat and sinus drainage

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-17
Dose 3 — Moderna
2021-11-18
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Frustration tolerance decreased, Patellofemoral pain syndrome, Pre-existing disease, Pyrexia — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Autistic frustration increased. Fever. Aches in joints. Level 4 chondromalacia in right knee.

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-20
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-11-21
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2021-11-22
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-23
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-24
Health check-in — day 7, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-12-01
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-22
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-29
Survey response — day 42, dose 3
MedDRA: Corneal dystrophy, Depression — Feeling: Good · Be unable to do your normal daily activities

Free text: Depression, Map Dot Fingerprint Corneal Dystrophy

MedDRA releases: 2024-11 · check-in free text available
2022-02-16
Survey response — 3 months, dose 3
MedDRA: Gastritis — Feeling: Fair · Be unable to do your normal daily activities

Free text: Gastritis and possible pancreatitis

MedDRA releases: 2024-11 · check-in free text available
2022-05-20
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-17
Survey response — 12 months, dose 3
MedDRA: Aphasia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Temporary loss of speech

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-22	Moderna
2	2021-05-20	Moderna
3	2021-11-17	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 7 — day 0, dose 1

2021-04-22

Systemic reaction (other): Flushed feeling and mild disorientation

Release 8 — days 1–6 daily, dose 2

2021-05-22

Healthcare visit (other): Psychotherapy

Release 8 — day 14, dose 2

2021-06-03

Symptoms: Chest pains, difficulty breathing

Release 9 — day 21, dose 2

2021-06-10

Symptoms: Depression, acid reflux, difficulty breathing

Release 9 — day 28, dose 2

2021-06-17

Symptoms: Compulsive behavior

Release 9 — 3 months, dose 2

2021-08-19

Symptoms: Multiple fevers, extreme apex headache, muscle and joint pain, ear pain and redness, mild sore throat and sinus drainage

Release 10 — 6 months, dose 2

2021-11-18

Symptoms: Autistic frustration increased. Fever. Aches in joints. Level 4 chondromalacia in right knee.

Release 10 — day 42, dose 3

2021-12-29

Symptoms: Depression, Map Dot Fingerprint Corneal Dystrophy

Release 11 — 3 months, dose 3

2022-02-16

Symptoms: Gastritis and possible pancreatitis

Release 12 — 12 months, dose 3

2022-11-17

Symptoms: Temporary loss of speech

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	Aphasia	·	·	✓
SD	Arthralgia	✓	·	✓
SD	Chest pain	✓	✓	✓
SD	Corneal dystrophy	·	·	✓
SD	Depression	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Ear pain	✓	·	✓
SD	Erythema	✓	·	✓
SD	Frustration tolerance decreased	·	·	✓
SD	Gastritis	·	·	✓
SD	Gastrooesophageal reflux disease	✓	✓	✓
SD	Headache	✓	·	✓
SD	Myalgia	✓	·	✓
SD	Obsessive-compulsive disorder	✓	✓	✓
SD	Oropharyngeal pain	✓	·	✓
SD	Paranasal sinus hypersecretion	✓	·	✓
SD	Patellofemoral pain syndrome	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	✓	·	✓
SRO	Disorientation	✓	✓	✓
SRO	Flushing	✓	✓	✓

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