YJD-23617-98014

4 vaccinations 8 coded responses 24 check-ins 8 free-text entries 0 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 471 / IN
Registered: 2021-05-29

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

2021-03-06
Dose 1 — Pfizer-BioNTech
2021-03-27
Dose 2 — Pfizer-BioNTech
2021-05-29
Registered in v-safe
2021-06-26
Survey response — 3 months, dose 2
MedDRA: Asthenia, Diverticulitis, Lethargy — Feeling: Fair · Be unable to work or attend school

Free text: For 2 months following my Mar27 second Pfizer vaccine, I experienced lethargy that did not prevent me from working, but low energy. May 19, I experience diverticulitis that progressed to acute diverticulitis.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-25
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-21
Dose 3 — Moderna
Co-administered: Flu
2021-11-29
Survey response — day 7, dose 3
MedDRA: Asthenia — Feeling: Good · Site: Pain

Free text: I had low energy the day of and day after injectioins

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Survey response — day 14, dose 3
MedDRA: Dermatitis acneiform, Rash, Rash erythematous — Feeling: Good

Free text: Four small red bumps on my face and back, they seem to be going away. Similar to pimples, but no head or pus.

MedDRA releases: 2024-11 · check-in free text available
2021-12-12
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-19
Survey response — day 28, dose 3
MedDRA: Oral mucosal eruption, Rash — Feeling: Fair

Free text: Previously I described a few bumps after Moderna booster (1st & 2nd doses were Pfizer), those bumps cleared up. Now I have 3 new bumps at the right corner of my mouth. They are not the same as cold sores, maybe these sites reacting to the booster?

MedDRA releases: 2024-11 · check-in free text available
2021-12-26
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-04
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-22
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-24
Survey response — 6 months, dose 3
MedDRA: Cough, Influenza, Nasopharyngitis, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Good

Free text: Cold/Flu symptoms, runny nose & coughing, lasted 2 -3 days, took at home COVID test, results were negative (no COVID indication)

MedDRA releases: 2024-11 · check-in free text available
2022-07-14
Dose 4 — Moderna
2022-07-14
Health check-in — day 0, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-07-15
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-07-16
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-07-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-07-19
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-07-20
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-07-21
Health check-in — day 7, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-07-28
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-08-04
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-08-11
Survey response — day 28, dose 4
MedDRA: Fatigue, Headache, Paranasal sinus hypersecretion — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Tired, sinus drainage, headache

MedDRA releases: 2024-11 · check-in free text available
2022-08-20
Survey response — day 35, dose 4
MedDRA: Asthenia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Ever since I got the last vaccine, I have experienced low energy compared to prior to the vaccine, and compared to my normal energy level. While this has not stopped my normal activities completely, it has impacted how much I can do dramatically

MedDRA releases: 2024-11 · check-in free text available
2022-08-25
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-10-13
Survey response — 3 months, dose 4
MedDRA: Paranasal sinus hypersecretion, Productive cough, SARS-CoV-2 test negative — Feeling: Fair · Be unable to do your normal daily activities

Free text: Sinus drainage, coughing with sputum, this has been going on for 4 weeks. I've taken 4 at home COVID tests all show negative.

MedDRA releases: 2024-11 · check-in free text available
2023-01-12
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-06	Pfizer-BioNTech
2	2021-03-27	Pfizer-BioNTech
3	2021-11-21	Moderna	Flu
4	2022-07-14	Moderna	No

Free text

Release 9 — 3 months, dose 2

2021-06-26

Symptoms: For 2 months following my Mar27 second Pfizer vaccine, I experienced lethargy that did not prevent me from working, but low energy. May 19, I experience diverticulitis that progressed to acute diverticulitis.

Release 10 — day 7, dose 3

2021-11-29

Systemic reaction (other): I had low energy the day of and day after injectioins

Release 10 — day 14, dose 3

2021-12-06

Symptoms: Four small red bumps on my face and back, they seem to be going away. Similar to pimples, but no head or pus.

Release 10 — day 28, dose 3

2021-12-19

Symptoms: Previously I described a few bumps after Moderna booster (1st & 2nd doses were Pfizer), those bumps cleared up. Now I have 3 new bumps at the right corner of my mouth. They are not the same as cold sores, maybe these sites reacting to the booster? cut off by CDC

Release 11 — 6 months, dose 3

2022-05-24

Symptoms: Cold/Flu symptoms, runny nose & coughing, lasted 2 -3 days, took at home COVID test, results were negative (no COVID indication)

Release 12 — day 28, dose 4

2022-08-11

Symptoms: Tired, sinus drainage, headache

Release 12 — day 35, dose 4

2022-08-20

Symptoms: Ever since I got the last vaccine, I have experienced low energy compared to prior to the vaccine, and compared to my normal energy level. While this has not stopped my normal activities completely, it has impacted how much I can do dramatically

Release 12 — 3 months, dose 4

2022-10-13

Symptoms: Sinus drainage, coughing with sputum, this has been going on for 4 weeks. I've taken 4 at home COVID tests all show negative.

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	Asthenia	✓	✓	✓
SD	Cough	·	·	✓
SD	Dermatitis acneiform	·	·	✓
SD	Diverticulitis	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Influenza	·	·	✓
SD	Lethargy	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Oral mucosal eruption	·	·	✓
SD	Paranasal sinus hypersecretion	·	·	✓
SD	Productive cough	·	·	✓
SD	Rash	·	·	✓
SD	Rash erythematous	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Asthenia	·	·	✓

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