YWL-10179-84488

4 vaccinations 10 coded responses 36 check-ins 10 free-text entries 0 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 941 / CA
Registered: 2021-01-10

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

2021-01-08
Dose 1 — Moderna
2021-01-10
Registered in v-safe
2021-01-10
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Fatigue, Headache — Feeling: Fair · Site: Pain, Itching · Muscle or body aches

Free text: For first several hours after injection (Fri. 1/8, 11am PST ) had a little episodic dizziness, headache and general fatigue... last resolved after 24 hr's

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-15
Survey response — day 7, dose 1
MedDRA: SARS-CoV-2 test — Feeling: Good · Muscle or body aches

Free text: Possible/unconfirmed COVID exposure @ work; asymptomatic testing today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-05
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-06
Dose 2 — Moderna
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-02-20
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-01
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-13
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-22
Survey response — day 42, dose 2
MedDRA: Chest pain, Dyspnoea — Feeling: Fair

Free text: Some chest pain, shortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Health check-in — 3 months, dose 2
Feeling: Good

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

Adult check-in
2021-11-19
Dose 3 — Moderna
2022-02-07
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-07-28
Dose 4 — Moderna
2022-07-28
Survey response — day 0, dose 4
MedDRA: Disturbance in attention, Fatigue — Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Concentration difficulty / fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-07-30
Survey response — days 1–6 daily, dose 4
MedDRA: Brain fog — Feeling: Fair · Headache, Muscle or body aches

Free text: Brain fog

MedDRA releases: 2024-11 · check-in free text available
2022-07-31
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-08-01
Survey response — days 1–6 daily, dose 4
MedDRA: Lymph node pain, Lymphadenopathy, Office visit — Feeling: Good · Headache, Fatigue or tiredness

Free text: The day after, had a noticeably painful/swollen neck lymph gland, on same side as injection (checked out with pcp today),reduced and no longer painful but still swollen

MedDRA releases: 2024-11 · check-in free text available
2022-08-02
Survey response — days 1–6 daily, dose 4
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good · Fatigue or tiredness

Free text: Swollen neck lymph gland persists but reduced, not painful now

MedDRA releases: 2024-11 · check-in free text available
2022-08-03
Survey response — days 1–6 daily, dose 4
MedDRA: Lymphadenopathy — Feeling: Good · Fatigue or tiredness

Free text: Continued swollen L neck lymph-node, seems generally reduced though

MedDRA releases: 2024-11 · check-in free text available
2022-08-04
Survey response — day 7, dose 4
MedDRA: Lymphadenopathy — Feeling: Good · Fatigue or tiredness

Free text: L neck lymph still slightly swollen, reducing, not painful

MedDRA releases: 2024-11 · check-in free text available
2022-08-12
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-08-18
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-09-02
Survey response — day 35, dose 4
MedDRA: Cough, Fatigue — Feeling: Fair

Free text: Slight cough, fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-09-08
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-10-27
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-01-26
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-08	Moderna
2	2021-02-06	Moderna
3	2021-11-19	Moderna	No
4	2022-07-28	Moderna	No

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-10

Systemic reaction (other): For first several hours after injection (Fri. 1/8, 11am PST ) had a little episodic dizziness, headache and general fatigue... last resolved after 24 hr's

Release 2 — day 7, dose 1

2021-01-15

Systemic reaction (other): Possible/unconfirmed COVID exposure @ work; asymptomatic testing today

Release 6 — day 42, dose 2

2021-03-22

Symptoms: Some chest pain, shortness of breath

Release 12 — day 0, dose 4

2022-07-28

Systemic reaction (other): Concentration difficulty / fatigue

Release 12 — days 1–6 daily, dose 4

2022-07-30

Systemic reaction (other): Brain fog

2022-08-01

Systemic reaction (other): The day after, had a noticeably painful/swollen neck lymph gland, on same side as injection (checked out with pcp today),reduced and no longer painful but still swollen

2022-08-02

Systemic reaction (other): Swollen neck lymph gland persists but reduced, not painful now

2022-08-03

Systemic reaction (other): Continued swollen L neck lymph-node, seems generally reduced though

Release 12 — day 7, dose 4

2022-08-04

Systemic reaction (other): L neck lymph still slightly swollen, reducing, not painful

Release 12 — day 35, dose 4

2022-09-02

Symptoms: Slight cough, fatigue

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	Chest pain	✓	✓	✓
SD	Cough	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	·	·	✓
SRO	Brain fog	·	·	✓
SRO	Disturbance in attention	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Immediate post-injection reaction	○	○	○
SRO	Lymph node pain	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Office visit	·	·	✓
SRO	SARS-CoV-2 test	✓	✓	✓

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