64H-18770-25308

2 vaccinations 5 coded responses 25 check-ins 5 free-text entries 5 call cases

Sex: Male
Age at first dose: 31-35
ZIP prefix: 622 / IL
Registered: 2021-01-12

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

2021-01-12
Registered in v-safe
2021-01-12
Dose 1 — Moderna
2021-01-12
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · None

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-14
Survey response — days 1–6 daily, dose 1
MedDRA: Rash — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Rash across trunk, chest, armpits, groin

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Dyspnoea, Emergency care — Feeling: Poor · Site: Pain, Swelling, Itching · Rash, not including the immediate area around the injection site · 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

Free text: Dizzy, lightheaded, some difficulty breathing this morning , treated in emergency room

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Report sent to call center — days 1–6 daily, 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)
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Redness, Itching · Rash, not including the immediate area around the injection site

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Survey response — day 7, dose 1
MedDRA: Rash — Feeling: Good · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Diffuse rash across chest/neck, despite steroid and antihistamine use (previously seen/treated for probable anaphylaxis)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Report sent to call center — day 7, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-26
Health check-in — day 14, dose 1
Feeling: Good

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

Adult check-in
2021-02-09
Dose 2 — Moderna
2021-02-09
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 2
MedDRA: Office visit, Rash, Self-medication — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Rash across trunk, chest, neck, and on face · Healthcare visit (other): Visit for severe rash spreading on trunk, chest, neck, and onto face that did not relieve with high dose antihistamines

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-11
Survey response — days 1–6 daily, dose 2
MedDRA: Office visit, Rash — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Rash across check, neck, face needing treatment with steroids (not controlled with antihistamines) · Healthcare visit (other): Followed up with allergist on rash treatment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-10
Call 1 — Left Voicemail
2021-03-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-11
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-10
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-09
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-12	Moderna
2	2021-02-09	Moderna

Call center

5 call center cases

5 unsuccessful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-14

Systemic reaction (other): Rash across trunk, chest, armpits, groin

2021-01-15

Systemic reaction (other): Dizzy, lightheaded, some difficulty breathing this morning , treated in emergency room

Release 2 — day 7, dose 1

2021-01-19

Systemic reaction (other): Diffuse rash across chest/neck, despite steroid and antihistamine use (previously seen/treated for probable anaphylaxis)

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): Rash across trunk, chest, neck, and on face

Healthcare visit (other): Visit for severe rash spreading on trunk, chest, neck, and onto face that did not relieve with high dose antihistamines

2021-02-11

Systemic reaction (other): Rash across check, neck, face needing treatment with steroids (not controlled with antihistamines)

Healthcare visit (other): Followed up with allergist on rash treatment

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	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Emergency care	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Self-medication	✓	✓	✓

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