6CE-23049-92970

5 vaccinations 7 coded responses 34 check-ins 7 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 891 / NV
Registered: 2021-01-14

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

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness, Swelling · None

Adult check-in
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Body temperature decreased — Feeling: Good · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness

Free text: Normal po temp 95.5Â°F ear 97.5Â°F

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Survey response — days 1–6 daily, dose 1
MedDRA: Diarrhoea, Frequent bowel movements — Feeling: Good · Site: Pain, Redness, Swelling · Abdominal pain

Free text: Frequent looser stools, more than normal x 2 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite, Diarrhoea — Feeling: Good · Site: Redness · Diarrhea

Free text: Stools remain lopseandmore frequent than norman, slight loss of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite, Diarrhoea, Frequent bowel movements — Feeling: Good · Muscle or body aches, Abdominal pain

Free text: Loose stools , increased frequency of bowel movement, slight loss of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-11
Dose 2 — Moderna
2021-02-11
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-12
Survey response — days 1–6 daily, dose 2
MedDRA: Body temperature decreased — Feeling: Good · Site: Pain · Fever · Fatigue or tiredness

Free text: Normal p.o. temp 95.6..

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fever · Fatigue or tiredness, Diarrhea

Adult check-in
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Po temp n = 95.4-95.6

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-18
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
2021-03-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-18
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
2021-05-13
Survey response — 3 months, dose 2
MedDRA: Body temperature increased, Bronchitis, Chest X-ray, Cough, Illness, Medical counselling, Pneumonia viral, SARS-CoV-2 test negative, Weight decreased — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Viral Pneumonia vs acute Bronchitis, COVID19 Rapid Test negative, febrile max 100Â°F po (N =97.4-.8Â°F po),paroxysmal cough, no loss of taste or smell, weight loss of 8lbs, regained 5, duration 10days 4/6 - 18/2021. ?? Contact me. · Healthcare visit (other): Phone contact, CXR ordered day 7 of illness, performed afterthe 21st

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-12
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-08-30
Dose 3 — Moderna
2021-11-29
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-28
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-03-31
Dose 4 — Moderna
2022-04-14
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-18
Call 1 — Left Voicemail
2022-04-18
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-21
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-04-28
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-05
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-12
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-06-30
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-07-28
Dose 5 — Moderna
2022-10-27
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-01-28
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-11	Moderna
3	2021-08-30	Moderna	No
4	2022-03-31	Moderna	No
5	2022-07-28	Moderna	No

Call center

1 call center case

1 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-16

Systemic reaction (other): Normal po temp 95.5Â°F ear 97.5Â°F

2021-01-17

Systemic reaction (other): Frequent looser stools, more than normal x 2 days

2021-01-18

Systemic reaction (other): Stools remain lopseandmore frequent than norman, slight loss of appetite

2021-01-19

Systemic reaction (other): Loose stools , increased frequency of bowel movement, slight loss of appetite

Release 4 — days 1–6 daily, dose 2

2021-02-12

Systemic reaction (other): Normal p.o. temp 95.6..

2021-02-16

Systemic reaction (other): Po temp n = 95.4-95.6

Release 8 — 3 months, dose 2

2021-05-13

Symptoms: Viral Pneumonia vs acute Bronchitis, COVID19 Rapid Test negative, febrile max 100Â°F po (N =97.4-.8Â°F po),paroxysmal cough, no loss of taste or smell, weight loss of 8lbs, regained 5, duration 10days 4/6 - 18/2021. ?? Contact me.

Healthcare visit (other): Phone contact, CXR ordered day 7 of illness, performed afterthe 21st

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	Chest X-ray	○	✓	○
HCVO	Illness	✓	·	✓
HCVO	Medical counselling	✓	✓	✓
SD	Body temperature increased	✓	·	✓
SD	Bronchitis	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Pneumonia viral	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Weight decreased	✓	✓	✓
SRO	Body temperature decreased	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Frequent bowel movements	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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