5TV-27850-61502

3 vaccinations 14 coded responses 26 check-ins 13 free-text entries 2 call cases

Sex: Male
Age at first dose: 26-30
ZIP prefix: 980 / WA
Registered: 2021-04-23

Relationship: Self
Race: Asian
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-04-23
Registered in v-safe
2021-04-23
Dose 1 — Moderna
2021-04-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-28
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-29
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-30
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-07
Survey response — day 14, dose 1
MedDRA: Haematochezia — Feeling: Poor

Free text: Observed bleeding along with the stool

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Survey response — day 21, dose 1
MedDRA: Rectal haemorrhage — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Bleeding in the rectile

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
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)
2021-05-21
Survey response — day 28, dose 1
MedDRA: Haematochezia, Headache, Laziness, Pain, Rectal haemorrhage — 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

Free text: Rectal bleeding: observed twice blood in the poopLazy, body pains, headache.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
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)
2021-05-28
Dose 2 — Moderna
2021-05-29
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-30
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-31
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-06-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches · Be unable to work

Adult check-in
2021-06-02
Survey response — days 1–6 daily, dose 2
MedDRA: Cardiac discomfort, Heart rate increased — Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Feeling like heart size is increasing and increase in weight

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-06-04
Survey response — day 7, dose 2
MedDRA: Chest discomfort — Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches · Be unable to work, Be unable to do your normal daily activities

Free text: Feeling wait in the chest area

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-13
Survey response — day 14, dose 2
MedDRA: Disturbance in attention, Memory impairment, Rectal haemorrhage — Feeling: Fair · Be unable to do your normal daily activities

Free text: Rectal bleedingForgetting many thingsNot able to focus on anythingAbove are the major differences I have observed in myself from the time after taking vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-20
Survey response — day 21, dose 2
MedDRA: Rectal haemorrhage — Feeling: Fair · Be unable to do your normal daily activities

Free text: Rectal bleeding

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-25
Survey response — day 28, dose 2
MedDRA: Rectal haemorrhage — Feeling: Fair · Be unable to work or attend school

Free text: Rectale bleeding

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-02
Survey response — day 35, dose 2
MedDRA: Haematochezia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Blood coming out along with stool

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-11
Survey response — day 42, dose 2
MedDRA: Rectal haemorrhage — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Rectal bleeding

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-27
Survey response — 3 months, dose 2
MedDRA: Rectal haemorrhage — Feeling: Fair · Be unable to do your normal daily activities

Free text: Blood in the rectile.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-04-08
Dose 3 — Moderna
2022-05-01
Call 1 — Left Voicemail
2022-05-06
Survey response — day 28, dose 3
MedDRA: Headache — Feeling: Poor · Be unable to do your normal daily activities

Free text: Headache

MedDRA releases: 2024-11 · check-in free text available
2022-05-20
Survey response — day 42, dose 3
MedDRA: Haematochezia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Blood in stool

MedDRA releases: 2024-11 · check-in free text available
2023-04-11
Survey response — 12 months, dose 3
MedDRA: Laziness, Pain — Feeling: Poor · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-23	Moderna
2	2021-05-28	Moderna
3	2022-04-08	Moderna	No

Call center

2 call center cases

2 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 8 — day 14, dose 1

2021-05-07

Symptoms: Observed bleeding along with the stool

Release 8 — day 21, dose 1

2021-05-14

Symptoms: Bleeding in the rectile

Release 8 — day 28, dose 1

2021-05-21

Symptoms: Rectal bleeding: observed twice blood in the poopLazy, body pains, headache.

Release 8 — days 1–6 daily, dose 2

2021-06-02

Systemic reaction (other): Feeling like heart size is increasing and increase in weight

Release 8 — day 7, dose 2

2021-06-04

Systemic reaction (other): Feeling wait in the chest area

Release 9 — day 14, dose 2

2021-06-13

Symptoms: Rectal bleedingForgetting many thingsNot able to focus on anythingAbove are the major differences I have observed in myself from the time after taking vaccine

Release 9 — day 21, dose 2

2021-06-20

Symptoms: Rectal bleeding

Release 9 — day 28, dose 2

2021-06-25

Symptoms: Rectale bleeding

Release 9 — day 35, dose 2

2021-07-02

Symptoms: Blood coming out along with stool

Release 9 — day 42, dose 2

2021-07-11

Symptoms: Rectal bleeding

Release 9 — 3 months, dose 2

2021-08-27

Symptoms: Blood in the rectile.

Release 11 — day 28, dose 3

2022-05-06

Symptoms: Headache

Release 11 — day 42, dose 3

2022-05-20

Symptoms: Blood in stool

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	Disturbance in attention	✓	✓	✓
SD	Haematochezia	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Laziness	·	·	✓
SD	Memory impairment	✓	✓	✓
SD	Pain	·	·	✓
SD	Rectal haemorrhage	✓	✓	✓
SRO	Cardiac discomfort	·	·	✓
SRO	Chest discomfort	✓	✓	✓
SRO	Heart rate increased	✓	✓	○

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