5VW-39008-64095

5 vaccinations 15 coded responses 43 check-ins 15 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 303 / GA
Registered: 2021-01-28

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

2021-01-28
Registered in v-safe
2021-01-28
Dose 1 — Moderna
2021-01-28
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-29
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal discomfort — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: Very mild upset stomach

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Joint pains

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-01
Survey response — days 1–6 daily, dose 1
MedDRA: Insomnia — Feeling: Good · Fatigue or tiredness

Free text: slept late.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-18
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-25
Dose 2 — Moderna
2021-02-25
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: Malaise — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Malaise

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-04
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-08
Survey response — day 42, dose 2
MedDRA: Chills, Oropharyngeal pain, Respiratory tract congestion — Feeling: Poor · Be unable to do your normal daily activities

Free text: Sore throat, congestion, Chills

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Survey response — 3 months, dose 2
MedDRA: Ear pain, Pneumonia, Pyrexia, Sinusitis — Feeling: Good

Free text: 5 May Low grade fever, lung infection, sinus infection24 May Ear ache, sinus infection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-23
Dose 3 — Moderna
2021-08-26
Survey response — 6 months, dose 2
MedDRA: Tinnitus — Feeling: Fair

Free text: Tinnitus

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-22
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-21
Survey response — 6 months, dose 3
MedDRA: COVID-19, Fatigue, Headache, Oropharyngeal pain — Feeling: Good

Free text: Covid 19, positive 29 Dec 2021, 5 Jan 2022, negative 12 Jan 2022. Mild symptoms, headache, sore throat, tiredness that lingered a few weeks.

MedDRA releases: 2024-11 · check-in free text available
2022-05-23
Dose 4 — Moderna
2022-06-26
Survey response — day 28, dose 4
MedDRA: Upper respiratory tract congestion — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Upper respiratory congestion

MedDRA releases: 2024-11 · check-in free text available
2022-06-26
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-27
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-27
Call 1 — Left Voicemail
2022-06-27
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-04
Survey response — day 42, dose 4
MedDRA: Tinnitus — Feeling: Fair

Free text: Tinnitus

MedDRA releases: 2024-11 · check-in free text available
2022-08-22
Survey response — 3 months, dose 4
MedDRA: Tinnitus — Feeling: Fair

Free text: Periodic Tinnitus.

MedDRA releases: 2024-11 · check-in free text available
2022-09-27
Dose 5 — Moderna
2022-09-30
Survey response — days 1–6 daily, dose 5
MedDRA: Tinnitus — Feeling: Fair · Site: Pain, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Tinnitus

MedDRA releases: 2024-11 · check-in free text available
2022-10-01
Survey response — days 1–6 daily, dose 5
MedDRA: Tinnitus — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Tinnitus

MedDRA releases: 2024-11 · check-in free text available
2022-10-02
Survey response — days 1–6 daily, dose 5
MedDRA: Tinnitus — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Tinnitus

MedDRA releases: 2024-11 · check-in free text available
2022-10-03
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-04
Survey response — day 7, dose 5
MedDRA: Tinnitus — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Tinnitus

MedDRA releases: 2024-11 · check-in free text available
2022-10-11
Health check-in — day 14, dose 5
Feeling: Fair

Adult check-in
2022-10-18
Survey response — day 21, dose 5
MedDRA: Arthralgia, Headache, Injection site pain, Injection site pruritus, Tinnitus — Feeling: Fair

Free text: Tinnitus, headache. Itching and soreness at the injection site (It only came back in the last few days) Increased joint soreness.

MedDRA releases: 2024-11 · check-in free text available
2022-10-25
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-11-01
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2022-11-08
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2022-12-27
Health check-in — 3 months, dose 5
Feeling: Fair

Adult check-in
2023-03-30
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-28	Moderna
2	2021-02-25	Moderna
3	2021-08-23	Moderna	No
4	2022-05-23	Moderna	No
5	2022-09-27	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-01-29

Systemic reaction (other): Very mild upset stomach

2021-02-01

Systemic reaction (other): slept late.

Release 4 — days 1–6 daily, dose 2

2021-02-26

Systemic reaction (other): Malaise

Release 7 — day 42, dose 2

2021-04-08

Symptoms: Sore throat, congestion, Chills

Release 8 — 3 months, dose 2

2021-05-27

Symptoms: 5 May Low grade fever, lung infection, sinus infection24 May Ear ache, sinus infection.

Release 9 — 6 months, dose 2

2021-08-26

Symptoms: Tinnitus

Release 11 — 6 months, dose 3

2022-02-21

Symptoms: Covid 19, positive 29 Dec 2021, 5 Jan 2022, negative 12 Jan 2022. Mild symptoms, headache, sore throat, tiredness that lingered a few weeks.

Release 12 — day 28, dose 4

2022-06-26

Symptoms: Upper respiratory congestion

Release 12 — day 42, dose 4

2022-07-04

Symptoms: Tinnitus

Release 12 — 3 months, dose 4

2022-08-22

Symptoms: Periodic Tinnitus.

Release 12 — days 1–6 daily, dose 5

2022-09-30

Systemic reaction (other): Tinnitus

2022-10-01

Systemic reaction (other): Tinnitus

2022-10-02

Systemic reaction (other): Tinnitus

Release 12 — day 7, dose 5

2022-10-04

Systemic reaction (other): Tinnitus

Release 12 — day 21, dose 5

2022-10-18

Symptoms: Tinnitus, headache. Itching and soreness at the injection site (It only came back in the last few days) Increased joint soreness.

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	Arthralgia	·	·	✓
SD	Chills	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Ear pain	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Injection site pain	·	·	✓
SD	Injection site pruritus	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pneumonia	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Sinusitis	✓	✓	✓
SD	Tinnitus	✓	·	✓
SD	Upper respiratory tract congestion	·	·	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Tinnitus	·	·	✓

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