6YJ-10190-55297

4 vaccinations 8 coded responses 33 check-ins 8 free-text entries 0 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 627 / IL
Registered: 2021-02-08

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

2021-02-08
Registered in v-safe
2021-02-08
Dose 1 — Moderna
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-02-11
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair

Free text: A few times feeling dizzy. Once had to cetch myself from falling.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Survey response — days 1–6 daily, dose 1
MedDRA: Balance disorder, Dizziness, Ocular discomfort — Feeling: Poor · Be unable to do your normal daily activities

Free text: Moderate. Light headed, no sense of balance as need to hold onto a vertical object if walking too far. Been horizontal resting all day. Early in the day couldnt look at a TV.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Survey response — days 1–6 daily, dose 1
MedDRA: Balance disorder, Dizziness — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Balance and light head issues continue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Survey response — days 1–6 daily, dose 1
MedDRA: Vertigo — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Still have vertigo

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — day 7, dose 1
MedDRA: Vertigo — Feeling: Fair · Be unable to do your normal daily activities

Free text: Vertigo mild

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Health check-in — day 14, dose 1
Feeling: Fair

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

Adult check-in
2021-03-08
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-15
Dose 2 — Moderna
2021-03-15
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good

Free text: None.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-20
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Good

Free text: None feeling great. Vaccine shots didnt really affect me.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-29
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-14
Survey response — 3 months, dose 2
MedDRA: Nasopharyngitis — Feeling: Fair

Free text: Suffering from a weekend head cold.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-13
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-05
Dose 3 — Moderna
2022-03-15
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-04-11
Dose 4 — Moderna
2022-04-29
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
2022-05-11
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
2022-10-10
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-11
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-08	Moderna
2	2021-03-15	Moderna
3	2021-11-05	Moderna	No
4	2022-04-11	Moderna	No

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-11

Systemic reaction (other): A few times feeling dizzy. Once had to cetch myself from falling.

2021-02-12

Systemic reaction (other): Moderate. Light headed, no sense of balance as need to hold onto a vertical object if walking too far. Been horizontal resting all day. Early in the day couldnt look at a TV.

2021-02-13

Systemic reaction (other): Balance and light head issues continue

2021-02-14

Systemic reaction (other): Still have vertigo

Release 4 — day 7, dose 1

2021-02-15

Systemic reaction (other): Vertigo mild

Release 5 — days 1–6 daily, dose 2

2021-03-18

Systemic reaction (other): None.

Release 6 — days 1–6 daily, dose 2

2021-03-20

Systemic reaction (other): None feeling great. Vaccine shots didnt really affect me.

Release 9 — 3 months, dose 2

2021-06-14

Symptoms: Suffering from a weekend head cold.

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	Nasopharyngitis	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Balance disorder	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Ocular discomfort	✓	✓	✓
SRO	Vertigo	✓	✓	✓

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