6YF-16264-10302

5 vaccinations 9 coded responses 29 check-ins 9 free-text entries 0 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 104 / NY
Registered: 2021-04-03

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-02-28
Dose 1 — Moderna
2021-04-01
Dose 2 — Moderna
2021-04-03
Registered in v-safe
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains · Be unable to do your normal daily activities

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Joint pains

Adult check-in
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease, Vertigo — Feeling: Good

Free text: suffer from vertigo, which has been exacerbated by reactions to vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Good

Free text: dizziness persists

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

Free text: dizziness persists

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — day 14, dose 2
MedDRA: Dizziness, Headache, Vertigo — Feeling: Good

Free text: intermittent headaches; dizziness (from vertigo).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-01
Survey response — 3 months, dose 2
MedDRA: Eye pruritus, Hypersensitivity — Feeling: Good · Be unable to do your normal daily activities

Free text: never before experienced allergies: in generaland, specifically, to Japanese maple tree/pollen; left eye itches constantly.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-30
Survey response — 6 months, dose 2
MedDRA: Dust allergy, Hypersensitivity, Seasonal allergy — Feeling: Good · Be unable to do your normal daily activities

Free text: never before experienced allergies: pollen, dust, etc.

MedDRA releases: 2024-11 · check-in free text available
2021-12-23
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2022-04-01
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-04-11
Dose 4 — Moderna
2022-05-01
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-02
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-09
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-16
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-23
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-11
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-09
Dose 5 — Moderna
2022-10-10
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2022-10-19
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2022-10-23
Health check-in — day 14, dose 5
Feeling: Poor

Adult check-in
2022-10-31
Survey response — day 21, dose 5
MedDRA: COVID-19, Influenza, Nasopharyngitis — Feeling: Fair · Be unable to do your normal daily activities

Free text: caught bad cold or flu or Covid (again).

MedDRA releases: 2024-11 · check-in free text available
2022-11-06
Survey response — day 28, dose 5
MedDRA: Cough, Productive cough, Secretion discharge — Feeling: Fair · Be unable to do your normal daily activities

Free text: persistent cough and phlegm/mucus drainage

MedDRA releases: 2024-11 · check-in free text available
2022-11-13
Survey response — day 35, dose 5
MedDRA: Dyspnoea — Feeling: Good · Be unable to do your normal daily activities

Free text: shortness of breath.

MedDRA releases: 2024-11 · check-in free text available
2022-11-20
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-08
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-04-09
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-28	Moderna
2	2021-04-01	Moderna
3	2021-12-23	Pfizer-BioNTech	Flu
4	2022-04-11	Moderna	No
5	2022-10-09	Moderna	No

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): suffer from vertigo, which has been exacerbated by reactions to vaccine

2021-04-07

Systemic reaction (other): dizziness persists

Release 7 — day 7, dose 2

2021-04-09

Systemic reaction (other): dizziness persists

Release 7 — day 14, dose 2

2021-04-15

Symptoms: intermittent headaches; dizziness (from vertigo).

Release 9 — 3 months, dose 2

2021-07-01

Symptoms: never before experienced allergies: in generaland, specifically, to Japanese maple tree/pollen; left eye itches constantly.

Release 9 — 6 months, dose 2

2021-09-30

Symptoms: never before experienced allergies: pollen, dust, etc.

Release 12 — day 21, dose 5

2022-10-31

Symptoms: caught bad cold or flu or Covid (again).

Release 12 — day 28, dose 5

2022-11-06

Symptoms: persistent cough and phlegm/mucus drainage

Release 12 — day 35, dose 5

2022-11-13

Symptoms: shortness of breath.

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	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Dust allergy	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Eye pruritus	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Influenza	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Productive cough	·	·	✓
SD	Seasonal allergy	·	·	✓
SD	Secretion discharge	·	·	✓
SD	Vertigo	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Vertigo	✓	✓	✓

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