6BV-21196-00163

2 vaccinations 11 coded responses 23 check-ins 11 free-text entries 4 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 481 / MI
Registered: 2021-04-16

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-04-16
Registered in v-safe
2021-04-16
Dose 1 — Moderna
2021-04-16
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-17
Survey response — days 1–6 daily, dose 1
MedDRA: Bradykinesia — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Very slow on movie

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
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)
2021-04-19
Survey response — days 1–6 daily, dose 1
MedDRA: Dry mouth — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Very dry mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-26
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-30
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-09
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-15
Dose 2 — Moderna
2021-05-17
Survey response — days 1–6 daily, dose 2
MedDRA: Cough — Feeling: Fair · Site: Pain · Headache

Free text: Coughing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Survey response — days 1–6 daily, dose 2
MedDRA: Cough — Feeling: Fair

Free text: Coughing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Survey response — days 1–6 daily, dose 2
MedDRA: Cough — Feeling: Fair · Nausea, Vomiting

Free text: Coughing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Survey response — days 1–6 daily, dose 2
MedDRA: Cough — Feeling: Poor · Headache, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Coughing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Headache, Limb mass, Vomiting — Feeling: Poor · Headache, Vomiting, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: Coughing so hard give me headaches that makes me vomit also notice lumps in forearm left and right forearm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-22
Survey response — day 7, dose 2
MedDRA: Cough, Headache, Mass — Feeling: Fair · Headache · Be unable to do your normal daily activities

Free text: The lumps that was in the forearms are gone drinking plenty of water but the cough is still persisting which causes the headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-31
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-14
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-21
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-26
Survey response — day 42, dose 2
MedDRA: Mass, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Hospitalization

Free text: Symptoms: I keep breaking out with the lumps all over the body same doctor again on steroids · Healthcare visit (other): Blood work

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-26
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-01
Call 1 — Could Not Reach Participant
2021-07-07
Call 2 — Could Not Reach Participant
2021-08-16
Survey response — 3 months, dose 2
MedDRA: Gait inability, Mass, Muscular weakness — 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, Emergency room or emergency department visit

Free text: Receive lumps all over the body and makes it feel as my legs are brittle which causes me to be unable to walk

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-16
Report sent to call center — 3 months, dose 2
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)
2021-08-20
Call 1 — Could Not Reach Participant
2021-08-25
Call 2 — Could Not Reach Participant
2021-11-15
Survey response — 6 months, dose 2
MedDRA: Pneumonia — Feeling: Good · Be unable to work or attend school, 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: Double pneumonia

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-11-16
Call 1 — Could Not Reach Participant
2021-11-19
Call 2 — Could Not Reach Participant
2022-05-17
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-16	Moderna
2	2021-05-15	Moderna

Call center

4 call center cases

4 unsuccessful

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-17

Healthcare visit (other): Very slow on movie

2021-04-19

Systemic reaction (other): Very dry mouth

Release 8 — days 1–6 daily, dose 2

2021-05-17

Systemic reaction (other): Coughing

2021-05-18

Systemic reaction (other): Coughing

2021-05-19

Systemic reaction (other): Coughing

2021-05-20

Systemic reaction (other): Coughing

2021-05-21

Systemic reaction (other): Coughing so hard give me headaches that makes me vomit also notice lumps in forearm left and right forearm

Release 8 — day 7, dose 2

2021-05-22

Systemic reaction (other): The lumps that was in the forearms are gone drinking plenty of water but the cough is still persisting which causes the headache

Release 9 — day 42, dose 2

2021-06-26

Symptoms: I keep breaking out with the lumps all over the body same doctor again on steroids

Healthcare visit (other): Blood work

Release 9 — 3 months, dose 2

2021-08-16

Symptoms: Receive lumps all over the body and makes it feel as my legs are brittle which causes me to be unable to walk

Release 10 — 6 months, dose 2

2021-11-15

Symptoms: Double pneumonia

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	Bradykinesia	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Gait inability	✓	·	✓
SD	Mass	✓	✓	✓
SD	Muscular weakness	✓	·	✓
SD	Pneumonia	·	·	✓
SRO	Cough	✓	✓	✓
SRO	Dry mouth	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Limb mass	✓	✓	✓
SRO	Mass	✓	✓	✓
SRO	Vomiting	✓	✓	✓

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