6T4-31864-56292

3 vaccinations 15 coded responses 30 check-ins 15 free-text entries 4 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 109 / NY
Registered: 2021-01-12

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

2021-01-12
Registered in v-safe
2021-01-12
Dose 1 — Moderna
2021-01-12
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-13
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Throat irritation — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Slight cough. Slight scratchy throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Body temperature fluctuation, Feeling of body temperature change — Feeling: Good · Fatigue or tiredness

Free text: Body temperature seems to be out of sorts. Skin feels hot and cold at various times of the day. Nothing worrisome but something I noticed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling of body temperature change — Feeling: Good · Fatigue or tiredness

Free text: Strange hot and cold body temps. No fever.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-01-21
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-26
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-02-02
Survey response — day 21, dose 1
MedDRA: Amnesia, Feeling of body temperature change — Feeling: Good

Free text: Not sure if this counts but I have had a slight memory loss from one day to the next. Temperature flux is a bit off. Hot and cold. No elevated temperature. Continue normal daily routine. Mask wearing daily.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Dose 2 — Moderna
2021-02-09
Health check-in — day 0, dose 2
Feeling: Good · Headache

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 2
MedDRA: Self-medication — Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Tylenol helped.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 2
MedDRA: Body temperature fluctuation — Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Free text: Body temp seems to flucate with no fever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Chest discomfort, Cough — Feeling: Fair · Fatigue or tiredness

Free text: Slight cough. Tightness in chest. Not much. All in all not bad.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Respiratory tract congestion — Feeling: Good · Fatigue or tiredness

Free text: Cough and congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — day 7, dose 2
MedDRA: Dyspnoea — Feeling: Good · Chills

Free text: Slight shortness of breath - nothing major

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-02
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-16
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-24
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-11
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-12
Survey response — 6 months, dose 2
MedDRA: Fatigue, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Tired. · Healthcare visit (other): Primary care physician and cardiologist

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-12
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-19
Call 2 — Left Voicemail
2021-12-30
Dose 3 — Moderna
2022-02-09
Survey response — 12 months, dose 2
MedDRA: Pruritus, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Rashes on my body. Itchy blotches. Itchy feet and head chest

MedDRA releases: 2024-11 · check-in free text available
2022-02-09
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-02-10
Survey response — day 42, dose 3
MedDRA: Pruritus, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Itchy feet and scalp. Rash's on body.

MedDRA releases: 2024-11 · check-in free text available
2022-02-10
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-02-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-03-31
Survey response — 3 months, dose 3
MedDRA: Brain fog, Fatigue, Heart rate increased, Insomnia, Pre-existing disease, Tinnitus — Feeling: Fair · Be unable to do your normal daily activities

Free text: Brain fog, fatigue, chronic cough,rapid heart rate (occasional), occasionally losing sleep, ringing in the ears.

MedDRA releases: 2024-11 · check-in free text available
2022-06-30
Survey response — 6 months, dose 3
MedDRA: Atrial fibrillation, Cardiac disorder — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Heart issues AFIB

MedDRA releases: 2024-11 · check-in free text available
2022-06-30
Report sent to call center — 6 months, dose 3
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)
2022-07-01
Call 1 — Left Voicemail
2022-07-01
Call 1 — Left Voicemail
2022-07-01
Call 1 — Left Voicemail
2022-07-01
Call 1 — Left Voicemail
2022-12-30
Survey response — 12 months, dose 3
MedDRA: Atrial fibrillation, Dizziness, Fatigue, Poor quality sleep — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue. Dizzy. Restless sleep. AFIB

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-12	Moderna
2	2021-02-09	Moderna
3	2021-12-30	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

2 waits over 3 months for a first call

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-13

Systemic reaction (other): Slight cough. Slight scratchy throat

Release 2 — days 1–6 daily, dose 1

2021-01-15

Systemic reaction (other): Body temperature seems to be out of sorts. Skin feels hot and cold at various times of the day. Nothing worrisome but something I noticed

2021-01-16

Systemic reaction (other): Strange hot and cold body temps. No fever.

Release 3 — day 21, dose 1

2021-02-02

Symptoms: Not sure if this counts but I have had a slight memory loss from one day to the next. Temperature flux is a bit off. Hot and cold. No elevated temperature. Continue normal daily routine. Mask wearing daily.

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): Tylenol helped.

2021-02-11

Systemic reaction (other): Body temp seems to flucate with no fever

2021-02-13

Systemic reaction (other): Slight cough. Tightness in chest. Not much. All in all not bad.

2021-02-15

Systemic reaction (other): Cough and congestion

Release 4 — day 7, dose 2

2021-02-16

Systemic reaction (other): Slight shortness of breath - nothing major

Release 9 — 6 months, dose 2

2021-08-12

Symptoms: Tired.

Healthcare visit (other): Primary care physician and cardiologist

Release 11 — 12 months, dose 2

2022-02-09

Symptoms: Rashes on my body. Itchy blotches. Itchy feet and head chest

Release 11 — day 42, dose 3

2022-02-10

Symptoms: Itchy feet and scalp. Rash's on body.

Release 11 — 3 months, dose 3

2022-03-31

Symptoms: Brain fog, fatigue, chronic cough,rapid heart rate (occasional), occasionally losing sleep, ringing in the ears.

Release 12 — 6 months, dose 3

2022-06-30

Symptoms: Heart issues AFIB

Release 12 — 12 months, dose 3

2022-12-30

Symptoms: Fatigue. Dizzy. Restless sleep. AFIB

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	✓	·	✓
SD	Amnesia	✓	✓	✓
SD	Atrial fibrillation	·	·	✓
SD	Brain fog	·	·	✓
SD	Cardiac disorder	·	·	✓
SD	Dizziness	·	·	✓
SD	Fatigue	✓	·	✓
SD	Feeling of body temperature change	✓	✓	✓
SD	Heart rate increased	·	·	✓
SD	Insomnia	·	·	✓
SD	Poor quality sleep	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	·	·	✓
SD	Rash	·	·	✓
SD	Restlessness	·	·	○
SD	Tinnitus	·	·	✓
SRO	Body temperature fluctuation	✓	✓	✓
SRO	Chest discomfort	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Feeling of body temperature change	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Throat irritation	✓	✓	✓

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