6PX-33554-68698

2 vaccinations 11 coded responses 26 check-ins 11 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 446 / OH
Registered: 2021-02-08

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

2021-02-08
Registered in v-safe
2021-02-08
Dose 1 — Moderna
2021-02-08
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Good

Free text: None

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

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-13
Survey response — days 1–6 daily, dose 1
MedDRA: Night sweats — Feeling: Good

Free text: Night sweating (very mild) during sleep past two nights

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-22
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-01
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-08
Dose 2 — Moderna
2021-03-08
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Good

Free text: None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Elevated heart rate of 78. My normal at rest is 58-60

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate abnormal — Feeling: Fair · Site: Pain, Redness · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Heart rate now a bit below norm at 52. Have been sitting past 2.5 hrs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness · Fever · Chills, Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-03-12
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased, Rash — Feeling: Fair · Headache, Rash, not including the immediate area around the injection site

Free text: Elevated Heart rate resolved, now 54 at rest. Rash area posterior LLQ and RLQ hot to palp treating c Triamcinolone Acetonite cream 0.1% with no improvement to date

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Survey response — days 1–6 daily, dose 2
MedDRA: Rash pruritic — Feeling: Fair · Site: Redness, Itching · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional

Free text: Plan to all for personal visit to GP if rash/itching not diminished on Monday 3/15

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Rash, not including the immediate area around the injection site

Adult check-in
2021-03-15
Survey response — day 7, dose 2
MedDRA: Pruritus — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Itching reduced

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-29
Survey response — day 21, dose 2
MedDRA: Hypersensitivity, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Allergic reaction to vaccine started 24 hrs post 2nd injection txd topically with some improvements but no resolution then worsened 10 days later. Placed on 16 days series of 40 mg prednisone declining dosage with improvements · Healthcare visit (other): In person office visit with endocrinologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-05
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-12
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-19
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-08
Survey response — 3 months, dose 2
MedDRA: Hospitalisation, Hypersensitivity, Immune system disorder, Immunisation reaction, Nephrostomy, Office visit, Rash, Renal disorder, Systemic infection, Ureteral stent insertion — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Suspected by Doctors. Allergic reaction to Moderna (full body rash) caused lowered immune system allowing systemic infection unknown etiology. Invaded kidneys required hospitalization 6days, nephrostomy tube placement x2 followed by ureter stent x

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-08
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)
2021-06-21
Call 1 — Left Voicemail
2021-09-06
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-03-08
Survey response — 12 months, dose 2
MedDRA: Feeling abnormal, Hypersensitivity, Office visit, Urinary tract infection — 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

Free text: Symptoms: UTI continues. It seemed to have resolved by last fall, however I have not felt "normal " since the allergic reaction to the Moderna mRNA second injection. It should be noted that I had an injection of the J&J covid injection as a booster. · Healthcare visit (other): Close follow up with my Urologist and my Endocrinologist/primary care physician

MedDRA releases: 2024-11 · check-in free text available
2022-03-08
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-09
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-08	Moderna
2	2021-03-08	Moderna

Call center

4 call center cases

4 unsuccessful

See the call center timeline

Free text

Release 3 — day 0, dose 1

2021-02-08

Systemic reaction (other): None

Release 4 — days 1–6 daily, dose 1

2021-02-13

Systemic reaction (other): Night sweating (very mild) during sleep past two nights

Release 5 — day 0, dose 2

2021-03-08

Systemic reaction (other): None

Release 5 — days 1–6 daily, dose 2

2021-03-09

Systemic reaction (other): Elevated heart rate of 78. My normal at rest is 58-60

2021-03-10

Systemic reaction (other): Heart rate now a bit below norm at 52. Have been sitting past 2.5 hrs

2021-03-12

Systemic reaction (other): Elevated Heart rate resolved, now 54 at rest. Rash area posterior LLQ and RLQ hot to palp treating c Triamcinolone Acetonite cream 0.1% with no improvement to date

2021-03-13

Healthcare visit (other): Plan to all for personal visit to GP if rash/itching not diminished on Monday 3/15

Release 5 — day 7, dose 2

2021-03-15

Systemic reaction (other): Itching reduced

Release 6 — day 21, dose 2

2021-03-29

Symptoms: Allergic reaction to vaccine started 24 hrs post 2nd injection txd topically with some improvements but no resolution then worsened 10 days later. Placed on 16 days series of 40 mg prednisone declining dosage with improvements

Healthcare visit (other): In person office visit with endocrinologist.

Release 8 — 3 months, dose 2

2021-06-08

Symptoms: Suspected by Doctors. Allergic reaction to Moderna (full body rash) caused lowered immune system allowing systemic infection unknown etiology. Invaded kidneys required hospitalization 6days, nephrostomy tube placement x2 followed by ureter stent x

Release 11 — 12 months, dose 2

2022-03-08

Symptoms: UTI continues. It seemed to have resolved by last fall, however I have not felt "normal " since the allergic reaction to the Moderna mRNA second injection. It should be noted that I had an injection of the J&J covid injection as a booster.

Healthcare visit (other): Close follow up with my Urologist and my Endocrinologist/primary care physician

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	✓	✓	✓
HCVO	Rash pruritic	✓	✓	✓
SD	Feeling abnormal	·	·	✓
SD	Hospitalisation	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Immune system disorder	✓	✓	✓
SD	Immunisation reaction	✓	✓	✓
SD	Nephrostomy	✓	·	✓
SD	Office visit	✓	·	✓
SD	Rash	✓	✓	✓
SD	Renal disorder	✓	✓	✓
SD	Systemic infection	✓	✓	✓
SD	Ureteral stent insertion	✓	✓	✓
SD	Urinary tract infection	·	·	✓
SRO	Heart rate abnormal	✓	✓	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Night sweats	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	·	·	✓

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