5QU-27125-86197

1 vaccination 7 coded responses 15 check-ins 7 free-text entries 4 call cases

Sex: Male
Age at first dose: 41-45
ZIP prefix: 840 / UT
Registered: 2021-04-17

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

2021-04-17
Registered in v-safe
2021-04-17
Dose 1 — Moderna
2021-04-17
Survey response — day 0, dose 1
MedDRA: Asthenia, Dizziness, Heart rate irregular, Nervousness — Feeling: Fair · Chills, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Dizziness, rapid heart rate, shaky, weakness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-18
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Site: Pain

Free text: Deep muscle ache at injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-04-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-04-21
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-24
Survey response — day 7, dose 1
MedDRA: Insomnia — Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Trouble sleeping

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-01
Survey response — day 14, dose 1
MedDRA: Haemorrhage, Headache, Insomnia, Skin exfoliation — Feeling: Fair · Be unable to work, 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: Severe lack of sleep. I am not able to sleep more than three to four hours a night since receiving the vaccine. Severe skin splitting on my hands and feet to the point of bleeding. Mild headaches daily.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-01
Report sent to call center — day 14, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-08
Survey response — day 21, dose 1
MedDRA: Feeling of body temperature change, Hyperhidrosis, Hypertension, Tachycardia — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: tachycardia, high blood pressure, hot and cold sweats

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-08
Report sent to call center — day 21, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-15
Survey response — day 28, dose 1
MedDRA: Anxiety, Emergency care, Hypoxia, Sleep disorder, Tachycardia — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Tachycardia and Hypoxia. I was rushed to the ER for it on the 6th. I am still not able to sleep more than 4-5 hours, I also now have a major increase in anxiety.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Report sent to call center — day 28, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-22
Survey response — day 35, dose 1
MedDRA: Hypoxia, Tachycardia — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Tachycardia, hypoxia, severe open wounds that will not heal.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-22
Report sent to call center — day 35, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-29
Health check-in — day 42, dose 1
Feeling: Poor

Adult check-in
2021-07-17
Health check-in — 3 months, dose 1
Feeling: Fair

Adult check-in
2021-10-16
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2021-12-29
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-17
Health check-in — 12 months, dose 1
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-17	Moderna

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 7 — day 0, dose 1

2021-04-17

Systemic reaction (other): Dizziness, rapid heart rate, shaky, weakness

Release 7 — days 1–6 daily, dose 1

2021-04-18

Systemic reaction (other): Deep muscle ache at injection site

Release 7 — day 7, dose 1

2021-04-24

Systemic reaction (other): Trouble sleeping

Release 8 — day 14, dose 1

2021-05-01

Symptoms: Severe lack of sleep. I am not able to sleep more than three to four hours a night since receiving the vaccine. Severe skin splitting on my hands and feet to the point of bleeding. Mild headaches daily.

Release 8 — day 21, dose 1

2021-05-08

Symptoms: tachycardia, high blood pressure, hot and cold sweats

Release 8 — day 28, dose 1

2021-05-15

Symptoms: Tachycardia and Hypoxia. I was rushed to the ER for it on the 6th. I am still not able to sleep more than 4-5 hours, I also now have a major increase in anxiety.

Release 8 — day 35, dose 1

2021-05-22

Symptoms: Tachycardia, hypoxia, severe open wounds that will not heal.

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	Emergency care	✓	✓	✓
SD	Feeling of body temperature change	✓	✓	✓
SD	Haemorrhage	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hyperhidrosis	✓	✓	✓
SD	Hypertension	✓	✓	✓
SD	Hypoxia	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Skin exfoliation	✓	✓	✓
SD	Sleep disorder	✓	✓	✓
SD	Tachycardia	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Heart rate irregular	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Nervousness	✓	✓	✓

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