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6KW-27337-18460

5 vaccinations 17 coded responses 39 check-ins 16 free-text entries 1 call case
Sex
Male
Age at first dose
61-65
ZIP prefix
197 / DE
Registered
2021-03-28
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-03-28
    Registered in v-safe
  2. 2021-03-28
    Dose 1 — Moderna
  3. 2021-03-28
    Health check-in — day 0, dose 1
    Feeling: Fair · None
    Adult check-in
  4. 2021-03-29
    Survey response — days 1–6 daily, dose 1
    MedDRA: Paraesthesia oral — Feeling: Fair · Site: Pain · Headache, Muscle or body aches
    Free text: tongue sensation
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-03-30
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain · Muscle or body aches
    Adult check-in
  6. 2021-03-31
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain · Headache, Muscle or body aches
    Adult check-in
  7. 2021-04-01
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain · Muscle or body aches
    Adult check-in
  8. 2021-04-03
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Chills, Muscle or body aches
    Adult check-in
  9. 2021-04-04
    Health check-in — day 7, dose 1
    Feeling: Fair · Headache
    Adult check-in
  10. 2021-04-11
    Health check-in — day 14, dose 1
    Feeling: Fair
    Adult check-in
  11. 2021-04-18
    Health check-in — day 21, dose 1
    Feeling: Fair
    Adult check-in
  12. 2021-04-25
    Dose 2 — Moderna
  13. 2021-04-25
    Health check-in — day 0, dose 2
    Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Rash, not including the immediate area around the injection site
    Adult check-in
  14. 2021-04-26
    Survey response — days 1–6 daily, dose 2
    MedDRA: Malaise — Feeling: Fair · Site: Pain, Swelling · Chills, Muscle or body aches
    Free text: general malaise
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-04-28
    Survey response — days 1–6 daily, dose 2
    MedDRA: Malaise — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Rash, not including the immediate area around the injection site
    Free text: general malaise
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-04-29
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Muscle or body aches
    Adult check-in
  17. 2021-04-30
    Survey response — days 1–6 daily, dose 2
    MedDRA: Dizziness — Feeling: Fair · Fever · Chills, Headache, Muscle or body aches
    Free text: some mild lightheadedness/dizziness
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  18. 2021-05-02
    Survey response — day 7, dose 2
    MedDRA: Complex regional pain syndrome, Condition aggravated, Pre-existing disease — Feeling: Fair · Muscle or body aches, Diarrhea
    Free text: Increased moderate to severe RSD symptoms
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-05-09
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-05-16
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-05-23
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-05-30
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-06-06
    Survey response — day 42, dose 2
    MedDRA: Adverse reaction — Feeling: Fair
    Free text: See RSD.org (RSDSA). On 4/23/21 My Blood Chemistry,Hematology, Urinalyses -best since childhood; On 5/1/21, My best DEXA scan ever. I have tried my best to differentiate my RSD sxs from my vaccination sxs. The Moderna vaccine is outstanding. Thanks.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  24. 2021-07-25
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-10-24
    Survey response — 6 months, dose 2
    MedDRA: Bacterial infection, Medical counselling, Respiratory disorder, Respiratory syncytial virus infection, Sinusitis, Sputum discoloured, Unevaluable event, Upper respiratory tract infection, Viral infection — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation
    Free text: Symptoms: Caught RSV or other respiratory virus from 21 month old Grandson (I reside with my Grandson and family.) My respiratory symptoms evolved to a severe bacterial infection (sinus infection and URI with thick dark sputum); fortunately, cefdinir 300mg/BID · Healthcare visit (other): Mobile Phone Call
    MedDRA releases: 2024-11 · check-in free text available
  26. 2021-10-24
    Report sent to call center — 6 months, dose 2
    Get care from a doctor or other healthcare professional
    Telehealth, virtual health, or email health consultation · 1 call case(s)
  27. 2021-10-28
  28. 2021-11-16
    Dose 3 — Moderna
  29. 2022-04-25
    Health check-in — 12 months, dose 2
    Feeling: Good
    Adult check-in
  30. 2022-05-05
    Dose 4 — Moderna
  31. 2022-05-05
    Survey response — day 0, dose 4
    MedDRA: Arthralgia, Headache, Myalgia, Pain — Feeling: Good · Site: Pain · Be unable to work or attend school, Be unable to do your normal daily activities
    Free text: NONE, excluding my worsening daily CRPS/RSD symptoms [(e.g., Upper/Lower extremity and back) Joint pains, Muscle or body aches (including back of neck), and Headaches].
    MedDRA releases: 2024-11 · check-in free text available
  32. 2022-05-07
    Survey response — days 1–6 daily, dose 4
    MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches · Be unable to work or attend school, Be unable to do your normal daily activities
    Free text: Severe pain (throughout my body) above and beyond my CRPS/RSD "normal" pain (06MAY2022). Today (07MAY), pain is improving. My "normal" CRPS/RSD skin rashes/purpura (i.e., CRPS/RSD autoimmunity sxs) remain unchanged p/2nd booster.
    MedDRA releases: 2024-11 · check-in free text available
  33. 2022-05-09
    Health check-in — days 1–6 daily, dose 4
    Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches
    Adult check-in
  34. 2022-05-11
    Survey response — days 1–6 daily, dose 4
    MedDRA: Unevaluable event — Feeling: Good · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities
    Free text: Aetna Medicare Drug Rx Appeal: M22B34DUKY6 C2C Innovative Solutions Medicare Appeal Number: 1-10972630107 (received 18MAR2022)
    MedDRA releases: 2024-11 · check-in free text available
  35. 2022-05-14
    Survey response — day 7, dose 4
    MedDRA: Unevaluable event — Feeling: Fair
    Free text: Today, I attended a Memorial Service in West Chester, PA, with >80 people in attendance.
    MedDRA releases: 2024-11 · check-in free text available
  36. 2022-05-19
    Survey response — day 14, dose 4
    MedDRA: Arthralgia, Back pain, Condition aggravated, Neck pain, Pre-existing disease — Feeling: Fair
    Free text: My CRPS sxs (e.g., R shoulder/back of neck pain) have been worsening. Since my second Moderna booster, I have attended (maskless) a Memorial (14MAY) in (b)(6) (>50 attendees) and a movie, Sonic, w/my Grandson (15MAY) @(b)(6) (noon)
    MedDRA releases: 2024-11 · check-in free text available
  37. 2022-05-26
    Health check-in — day 21, dose 4
    Feeling: Good
    Adult check-in
  38. 2022-06-02
    Health check-in — day 28, dose 4
    Feeling: Good
    Adult check-in
  39. 2022-06-10
    Survey response — day 35, dose 4
    MedDRA: Complex regional pain syndrome — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities
    Free text: Worsening CRPS symptoms.
    MedDRA releases: 2024-11 · check-in free text available
  40. 2022-06-17
    Survey response — day 42, dose 4
    MedDRA: Complex regional pain syndrome — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities
    Free text: Worsening CRPS symptoms; however, on 12JUN2022, I attended (maskless) Jurassic World Movie at (b)(6) Mall (3:30pm ET) and on 17JUN2022, I went grocery shopping (maskless) at (b)(6), DE) at 10:00 am ET.
    MedDRA releases: 2024-11 · check-in free text available
  41. 2022-10-21
    Dose 5 — Pfizer-BioNTech
    Co-administered: Flu
  42. 2022-11-03
    Survey response — 6 months, dose 4
    MedDRA: Unevaluable event — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities
    Free text: In my opinion, CAR-T cell treatment should be both extremely safe and effective treatment (see below) for all autoimmunity/autoinflammatory symptoms (most, if not all, symptoms) of CRPS/RSDS!!! https://www.sciencenews.org/article/lupus-car-t-cell-
    MedDRA releases: 2024-11 · check-in free text available
  43. 2022-11-11
    Health check-in — day 21, dose 5
    Feeling: Fair
    Adult check-in
  44. 2022-11-19
    Health check-in — day 28, dose 5
    Feeling: Fair
    Adult check-in
  45. 2022-11-27
    Survey response — day 35, dose 5
    MedDRA: Autoimmune disorder, Complex regional pain syndrome, Exposure to communicable disease — Feeling: Poor · Be unable to do your normal daily activities
    Free text: Ongoing/worsening CRPS/RSD autoimmunity/autoinflammatory symptoms. My 2.8 year-old Grandson (whom I live with) has recently tested positive for swine influenza. My daughter-in-law has recently received Ciprodex ear drops, as well. No Covid.
    MedDRA releases: 2024-11 · check-in free text available
  46. 2022-12-02
    Health check-in — day 42, dose 5
    Feeling: Fair
    Adult check-in
  47. 2023-01-20
    Survey response — 3 months, dose 5
    MedDRA: Condition aggravated, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities
    MedDRA releases: 2024-11

Vaccinations

DoseDateManufacturerCo-administered
12021-03-28Moderna
22021-04-25Moderna
32021-11-16Moderna No
42022-05-05Moderna No
52022-10-21Pfizer-BioNTech Flu

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-29

Systemic reaction (other): tongue sensation

Release 8 — days 1–6 daily, dose 2

2021-04-26

Systemic reaction (other): general malaise

2021-04-28

Systemic reaction (other): general malaise

2021-04-30

Systemic reaction (other): some mild lightheadedness/dizziness

Release 8 — day 7, dose 2

2021-05-02

Systemic reaction (other): Increased moderate to severe RSD symptoms

Release 8 — day 42, dose 2

2021-06-06

Symptoms: See RSD.org (RSDSA). On 4/23/21 My Blood Chemistry,Hematology, Urinalyses -best since childhood; On 5/1/21, My best DEXA scan ever. I have tried my best to differentiate my RSD sxs from my vaccination sxs. The Moderna vaccine is outstanding. Thanks. cut off by CDC

Release 10 — 6 months, dose 2

2021-10-24

Symptoms: Caught RSV or other respiratory virus from 21 month old Grandson (I reside with my Grandson and family.) My respiratory symptoms evolved to a severe bacterial infection (sinus infection and URI with thick dark sputum); fortunately, cefdinir 300mg/BID cut off by CDC
Healthcare visit (other): Mobile Phone Call

Release 11 — day 0, dose 4

2022-05-05

Systemic reaction (other): NONE, excluding my worsening daily CRPS/RSD symptoms [(e.g., Upper/Lower extremity and back) Joint pains, Muscle or body aches (including back of neck), and Headaches].

Release 11 — days 1–6 daily, dose 4

2022-05-07

Systemic reaction (other): Severe pain (throughout my body) above and beyond my CRPS/RSD "normal" pain (06MAY2022). Today (07MAY), pain is improving. My "normal" CRPS/RSD skin rashes/purpura (i.e., CRPS/RSD autoimmunity sxs) remain unchanged p/2nd booster.

2022-05-11

Systemic reaction (other): Aetna Medicare Drug Rx Appeal: M22B34DUKY6 C2C Innovative Solutions Medicare Appeal Number: 1-10972630107 (received 18MAR2022)

Release 11 — day 7, dose 4

2022-05-14

Systemic reaction (other): Today, I attended a Memorial Service in West Chester, PA, with >80 people in attendance.

Release 11 — day 14, dose 4

2022-05-19

Symptoms: My CRPS sxs (e.g., R shoulder/back of neck pain) have been worsening. Since my second Moderna booster, I have attended (maskless) a Memorial (14MAY) in (b)(6) (>50 attendees) and a movie, Sonic, w/my Grandson (15MAY) @(b)(6) (noon)
redacted (b)(6)

Release 12 — day 35, dose 4

2022-06-10

Symptoms: Worsening CRPS symptoms.

Release 12 — day 42, dose 4

2022-06-17

Symptoms: Worsening CRPS symptoms; however, on 12JUN2022, I attended (maskless) Jurassic World Movie at (b)(6) Mall (3:30pm ET) and on 17JUN2022, I went grocery shopping (maskless) at (b)(6), DE) at 10:00 am ET.
redacted (b)(6)

Release 12 — 6 months, dose 4

2022-11-03

Symptoms: In my opinion, CAR-T cell treatment should be both extremely safe and effective treatment (see below) for all autoimmunity/autoinflammatory symptoms (most, if not all, symptoms) of CRPS/RSDS!!! https://www.sciencenews.org/article/lupus-car-t-cell- cut off by CDC

Release 12 — day 35, dose 5

2022-11-27

Symptoms: Ongoing/worsening CRPS/RSD autoimmunity/autoinflammatory symptoms. My 2.8 year-old Grandson (whom I live with) has recently tested positive for swine influenza. My daughter-in-law has recently received Ciprodex ear drops, as well. No Covid.

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

FieldPreferred term2021-092023-042024-11
HCVOMedical counselling · · ✓
SDAdverse reaction ✓ ✓ ✓
SDArthralgia · · ✓
SDAutoimmune disorder · · ✓
SDBack pain · · ✓
SDBacterial infection · · ✓
SDComplex regional pain syndrome · · ✓
SDCondition aggravated · · ✓
SDExposure to communicable disease · · ✓
SDNeck pain · · ✓
SDPre-existing disease · · ✓
SDRespiratory disorder · · ✓
SDRespiratory syncytial virus infection · · ✓
SDSinusitis · · ✓
SDSputum discoloured · · ✓
SDUnevaluable event · · ✓
SDUpper respiratory tract infection · · ✓
SDViral infection · · ✓
SROArthralgia · · ✓
SROComplex regional pain syndrome ✓ ✓ ○
SROCondition aggravated · · ✓
SRODizziness ✓ ✓ ✓
SROHeadache · · ✓
SROMalaise ✓ ✓ ✓
SROMyalgia · · ✓
SROPain · · ✓
SROParaesthesia oral ✓ ✓ ✓
SROPre-existing disease · · ✓
SROUnevaluable event · · ✓

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

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