5V6-71648-02711

1 vaccination 6 coded responses 16 check-ins 6 free-text entries 2 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 109 / NY
Registered: 2021-01-07

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

2021-01-07
Registered in v-safe
2021-01-07
Dose 1 — Moderna
2021-01-07
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-01-14
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-01-21
Survey response — day 14, dose 1
MedDRA: Abdominal discomfort, Fatigue, Headache, Nausea — Feeling: Fair

Free text: fatigue, nausea, abdominal discomfort, mild headaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — day 21, dose 1
MedDRA: Dizziness, Fatigue, Feeling hot, Headache, Nausea — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Nausea, headaches, light headedness, upper body heat discharges, fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Survey response — day 28, dose 1
MedDRA: Fatigue, Nausea — Feeling: Fair · Be unable to do your normal daily activities

Free text: increasing fatigue and continued nausea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-02-18
Survey response — day 42, dose 1
MedDRA: Dizziness, Fatigue, Feeling hot, Glossodynia, Syncope, Tongue haemorrhage — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: increasing fatigue; light-headedness to the point of almost passing out when I arise sometimes; tongue bleeding and pain; sensation of heat but body temperature actually being low-- 96 degrees

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — 3 months, dose 1
Feeling: Fair

Adult check-in
2021-07-08
Survey response — 6 months, dose 1
MedDRA: Glossodynia, Hot flush, Nausea, Neck pain, Office visit, Orthostatic hypotension — 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 · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Tongue pain , hot flashes, nausea, orthostatic hypotension , neck pain · Healthcare visit (other): Acupuncture, chiropractic, homeopathy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-08
Report sent to call center — 6 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-14
Call 1 — Could Not Reach Participant
2021-07-19
Call 2 — Left Voicemail
2022-01-07
Survey response — 12 months, dose 1
MedDRA: Chest discomfort, Fatigue, Glossodynia, Immunisation reaction, Nausea, Orthostatic hypotension — 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 · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: It took 8 months to recover from the vaccine. Tongue pain, orthostatic hypotension, nausea, fatigue, heat in my chest. This survey under reported side effects and didn't follow up appropriately. · Healthcare visit (other): Homeopathic treatment is the only thing that helped resolve my vaccine induced symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-01-07
Report sent to call center — 12 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-10
Call 1 — Could Not Reach Participant
2022-01-13
Call 2 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-07	Moderna

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 2 — day 14, dose 1

2021-01-21

Symptoms: fatigue, nausea, abdominal discomfort, mild headaches

Release 2 — day 21, dose 1

2021-01-28

Symptoms: Nausea, headaches, light headedness, upper body heat discharges, fatigue

Release 3 — day 28, dose 1

2021-02-04

Symptoms: increasing fatigue and continued nausea

Release 4 — day 42, dose 1

2021-02-18

Symptoms: increasing fatigue; light-headedness to the point of almost passing out when I arise sometimes; tongue bleeding and pain; sensation of heat but body temperature actually being low-- 96 degrees

Release 9 — 6 months, dose 1

2021-07-08

Symptoms: Tongue pain , hot flashes, nausea, orthostatic hypotension , neck pain

Healthcare visit (other): Acupuncture, chiropractic, homeopathy

Release 10 — 12 months, dose 1

2022-01-07

Symptoms: It took 8 months to recover from the vaccine. Tongue pain, orthostatic hypotension, nausea, fatigue, heat in my chest. This survey under reported side effects and didn't follow up appropriately.

Healthcare visit (other): Homeopathic treatment is the only thing that helped resolve my vaccine induced symptoms

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	Immunisation reaction	·	·	✓
HCVO	Office visit	✓	✓	✓
SD	Abdominal discomfort	✓	✓	✓
SD	Chest discomfort	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling hot	✓	✓	✓
SD	Glossodynia	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hot flush	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Neck pain	✓	✓	✓
SD	Orthostatic hypotension	✓	✓	✓
SD	Syncope	✓	✓	✓
SD	Tongue haemorrhage	✓	✓	✓

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