6TK-55429-43055

4 vaccinations 11 coded responses 29 check-ins 11 free-text entries 5 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 856 / AZ
Registered: 2021-01-20

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

2021-01-16
Dose 1 — Moderna
2021-01-20
Registered in v-safe
2021-02-13
Dose 2 — Moderna
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Rash macular, Swelling — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Swollen nickel sized spots on inside each elbow.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Joint swelling — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Small swelling inside both elbows

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Swelling in lymph nodes inside each elbow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Atrial fibrillation — Feeling: Fair · Site: Pain · Joint pains · Be unable to do your normal daily activities

Free text: Went into hospital on 2/17 with severe a fib Dont hone if connected with vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — day 7, dose 2
MedDRA: Atrial fibrillation, Hospitalisation, Lymphadenopathy — Feeling: Fair · Site: Pain · Joint pains · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Systemic reaction (other): Swollen lymph nodes inside both elbows. Atrial fibrillation severe for two nights in hospital. · Healthcare visit (other): A fib

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Report sent to call center — day 7, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-27
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-06
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-13
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-20
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-28
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-15
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-14
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-08-16
Call 2 — Left Voicemail
2021-09-07
Dose 3 — Moderna
2022-02-13
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-05-12
Dose 4 — Moderna
2022-05-12
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-05-13
Survey response — days 1–6 daily, dose 4
MedDRA: No adverse event — Feeling: Good · Site: Pain

Free text: None

MedDRA releases: 2024-11 · check-in free text available
2022-05-14
Survey response — days 1–6 daily, dose 4
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2022-05-15
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-16
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-19
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-27
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-04
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-09
Survey response — day 28, dose 4
MedDRA: Influenza A virus test positive, Medical counselling, Nasopharyngitis, SARS-CoV-2 test positive — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: On 6/6/2022 I tested positive for COVID and flu a. It's like a severe cold, but worse. · Healthcare visit (other): Telephone.

MedDRA releases: 2024-11 · check-in free text available
2022-06-09
Report sent to call center — day 28, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-06-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-16
Survey response — day 35, dose 4
MedDRA: Oropharyngeal pain — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sore throat

MedDRA releases: 2024-11 · check-in free text available
2022-06-16
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-17
Call 1 — Left Voicemail
2022-06-23
Survey response — day 42, dose 4
MedDRA: COVID-19, Influenza, Lethargy, Oropharyngeal pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Just recovering from COVID,still positive for flu-a. Still have a sore throat. Still lethargic.

MedDRA releases: 2024-11 · check-in free text available
2022-06-23
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-24
Call 2 — Left Voicemail
2022-06-24
Call 1 — Left Voicemail
2022-08-11
Survey response — 3 months, dose 4
MedDRA: COVID-19, Influenza, Office visit, Oropharyngeal pain, Upper-airway cough syndrome — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: I have a reoccurring sore throat sand postnatal drip. I had COVID and flu in June I've had two rounds of antibiotics. · Healthcare visit (other): Office visit three times.

MedDRA releases: 2024-11 · check-in free text available
2022-08-11
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-08-12
Call 1 — Left Voicemail
2022-08-12
Call 1 — Left Voicemail
2022-08-12
Call 3 — Left Voicemail
2022-08-12
Call 2 — Left Voicemail
2022-08-12
Call 1 — Left Voicemail
2022-11-12
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-12
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-16	Moderna
2	2021-02-13	Moderna
3	2021-09-07	Moderna	No
4	2022-05-12	Moderna	No

Call center

5 call center cases

2 successful · 3 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-15

Systemic reaction (other): Swollen nickel sized spots on inside each elbow.

2021-02-16

Systemic reaction (other): Small swelling inside both elbows

2021-02-17

Systemic reaction (other): Swelling in lymph nodes inside each elbow

2021-02-19

Systemic reaction (other): Went into hospital on 2/17 with severe a fib Dont hone if connected with vaccine.

Release 4 — day 7, dose 2

2021-02-22

Systemic reaction (other): Swollen lymph nodes inside both elbows. Atrial fibrillation severe for two nights in hospital.

Healthcare visit (other): A fib

Release 11 — days 1–6 daily, dose 4

2022-05-13

Systemic reaction (other): None

2022-05-14

Systemic reaction (other): No

Release 12 — day 28, dose 4

2022-06-09

Symptoms: On 6/6/2022 I tested positive for COVID and flu a. It's like a severe cold, but worse.

Healthcare visit (other): Telephone.

Release 12 — day 35, dose 4

2022-06-16

Symptoms: Sore throat

Release 12 — day 42, dose 4

2022-06-23

Symptoms: Just recovering from COVID,still positive for flu-a. Still have a sore throat. Still lethargic.

Release 12 — 3 months, dose 4

2022-08-11

Symptoms: I have a reoccurring sore throat sand postnatal drip. I had COVID and flu in June I've had two rounds of antibiotics.

Healthcare visit (other): Office visit three times.

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	Atrial fibrillation	✓	✓	✓
HCVO	Medical counselling	·	·	✓
HCVO	Office visit	·	·	✓
SD	COVID-19	·	·	✓
SD	Influenza	·	·	✓
SD	Influenza A virus test positive	·	·	✓
SD	Lethargy	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Upper-airway cough syndrome	·	·	✓
SRO	Atrial fibrillation	✓	✓	✓
SRO	Hospitalisation	✓	✓	✓
SRO	Joint swelling	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	No adverse event	·	·	✓
SRO	Rash macular	✓	✓	✓
SRO	Swelling	✓	✓	✓

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