6ND-14836-61781

3 vaccinations 14 coded responses 27 check-ins 14 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 489 / MI
Registered: 2021-03-11

Relationship: Self
Race: Black or African American
Ethnicity: N/A

Timeline

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

2021-03-03
Dose 1 — Moderna
2021-03-11
Registered in v-safe
2021-03-11
Survey response — day 7, dose 1
MedDRA: Abdominal discomfort — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Upset stomach

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-03-24
Survey response — day 21, dose 1
MedDRA: Fatigue, Hypertension — Feeling: Fair

Free text: Becoming more fatigued and my blood pressure seems to be high more often

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Dose 2 — Moderna
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Headache, Fatigue or tiredness

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-04-07
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-14
Survey response — day 14, dose 2
MedDRA: Dizziness, Nausea — Feeling: Poor · Be unable to do your normal daily activities

Free text: I have taken my blood pressure pills and I still can't get my blood pressure below 189/82 and it was 198/80 this morning before I took pills. I was feeling nauseated, light headed and very wealthy I still feel the same.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-28
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-05
Survey response — day 35, dose 2
MedDRA: Blood pressure increased, Fatigue, Rash — Feeling: Poor · Be unable to do your normal daily activities

Free text: A rise in blood pressure and a rash on my face and fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-02
Survey response — 3 months, dose 2
MedDRA: Oropharyngeal pain — Feeling: Poor

Free text: Sore through

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-29
Survey response — 6 months, dose 2
MedDRA: Back pain, Nasal congestion, Oropharyngeal pain — Feeling: Poor

Free text: Sore throat, stuffy nose and back pain

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Dose 3 — Moderna
2021-11-01
Survey response — days 1–6 daily, dose 3
MedDRA: Nasopharyngitis — Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Muscle or body aches, Fatigue or tiredness

Free text: Feeling like I have a cold

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Decreased appetite, Dizziness — Feeling: Fair · Site: Itching · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizzy feeling and lost of appetite

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — Feeling: Fair · Fatigue or tiredness

Free text: Coughing

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-11-06
Survey response — day 7, dose 3
MedDRA: Back pain — Feeling: Good · Muscle or body aches

Free text: Lower back aches

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-20
Survey response — day 21, dose 3
MedDRA: Back pain, Cough, Muscular weakness, Nasal congestion, Nasal odour, Tinnitus — Feeling: Poor

Free text: Lower back pain, stuffy nose, dry cough, weakness in my legs, bad odor coming from my nose and the ringing in my ear's seems to have gotten worse.

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-12
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-29
Survey response — 3 months, dose 3
MedDRA: Back pain, Headache, Hypoaesthesia, Tinnitus — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Numbness in my left arm and hand, back pain, ringing in ear, back pain, headach.

MedDRA releases: 2024-11 · check-in free text available
2022-01-29
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-02-01
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-30
Survey response — 6 months, dose 3
MedDRA: Back pain, Pain in extremity — Feeling: Fair

Free text: Back pains and pain in my hands and finger and legs.

MedDRA releases: 2024-11 · check-in free text available
2022-10-30
Survey response — 12 months, dose 3
MedDRA: Arthralgia, Back pain, Gait disturbance, Nasal congestion — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Pain in my left knee and lift side from my lower back so much so it is hard to walk stuffed up nostrils.

MedDRA releases: 2024-11 · check-in free text available
2022-10-30
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-03	Moderna
2	2021-03-31	Moderna
3	2021-10-30	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 5 — day 7, dose 1

2021-03-11

Systemic reaction (other): Upset stomach

Release 6 — day 21, dose 1

2021-03-24

Symptoms: Becoming more fatigued and my blood pressure seems to be high more often

Release 7 — day 14, dose 2

2021-04-14

Symptoms: I have taken my blood pressure pills and I still can't get my blood pressure below 189/82 and it was 198/80 this morning before I took pills. I was feeling nauseated, light headed and very wealthy I still feel the same.

Release 8 — day 35, dose 2

2021-05-05

Symptoms: A rise in blood pressure and a rash on my face and fatigue

Release 9 — 3 months, dose 2

2021-07-02

Symptoms: Sore through

Release 9 — 6 months, dose 2

2021-09-29

Symptoms: Sore throat, stuffy nose and back pain

Release 10 — days 1–6 daily, dose 3

2021-11-01

Systemic reaction (other): Feeling like I have a cold

2021-11-03

Systemic reaction (other): Dizzy feeling and lost of appetite

2021-11-04

Systemic reaction (other): Coughing

Release 10 — day 7, dose 3

2021-11-06

Systemic reaction (other): Lower back aches

Release 10 — day 21, dose 3

2021-11-20

Symptoms: Lower back pain, stuffy nose, dry cough, weakness in my legs, bad odor coming from my nose and the ringing in my ear's seems to have gotten worse.

Release 11 — 3 months, dose 3

2022-01-29

Symptoms: Numbness in my left arm and hand, back pain, ringing in ear, back pain, headach.

Release 11 — 6 months, dose 3

2022-04-30

Symptoms: Back pains and pain in my hands and finger and legs.

Release 12 — 12 months, dose 3

2022-10-30

Symptoms: Pain in my left knee and lift side from my lower back so much so it is hard to walk stuffed up nostrils.

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	Back pain	·	·	✓
SD	Blood pressure increased	✓	✓	✓
SD	Cough	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gait disturbance	·	·	✓
SD	Headache	·	·	✓
SD	Hypertension	✓	✓	✓
SD	Hypoaesthesia	·	·	✓
SD	Muscular weakness	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Nasal odour	·	·	✓
SD	Nausea	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain in extremity	·	·	✓
SD	Rash	✓	✓	✓
SD	Tinnitus	·	·	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Back pain	·	·	✓
SRO	Cough	·	·	✓
SRO	Decreased appetite	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Nasopharyngitis	·	·	✓

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