Z5K-32195-27212

4 vaccinations 14 coded responses 50 check-ins 14 free-text entries 0 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 191 / PA
Registered: 2021-02-10

Relationship: Self
Race: Black or African American
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

2021-02-10
Registered in v-safe
2021-02-10
Dose 1 — Moderna
2021-02-10
Survey response — day 0, dose 1
MedDRA: Dizziness — Feeling: Good · Site: Redness · Chills

Free text: Little lite headedness. Mild indication of Flu Vaccine type conditions.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Good · Site: Pain · Fever · Chills

Free text: Continued indications of Flu Vaccine type conditions

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: Pyrexia, Self-medication — Feeling: Good · Site: Pain · Fever · Chills

Free text: Over night mild fever like conditions. This morning took some Tylenol feel fine.

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: Self-medication — Feeling: Good · Site: Pain · Chills

Free text: Took Tylenol ate a piece of beef. Feel great.

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: Unevaluable event — Feeling: Good · Diarrhea

Free text: It is what it is;

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 1
MedDRA: Chills — Feeling: Good · Fever · Chills

Free text: The heat does not appeal to certain residents so they turn the furnace off and I keep a constant chill. Then I turn my space heater on.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Good · Nausea

Free text: Could be due to the brown guacamole I ate Saturday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — day 7, dose 1
MedDRA: Unevaluable event — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: First day out since receiving the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Health check-in — day 14, dose 1
Feeling: Good

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

Adult check-in
2021-03-10
Dose 2 — Moderna
2021-03-10
Survey response — day 0, dose 2
MedDRA: Hypertension, Pre-existing disease, Thrombosis — Feeling: Good · Site: Pain · Fever · Chills, Muscle or body aches

Free text: Diabetes, Heart Disease, Hypertension, Blood Clot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — days 1–6 daily, dose 2
MedDRA: Influenza like illness — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness, Nausea

Free text: Awoke this morning with moderate flulike symptoms. Ate took my meds and vitamins feel fare

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Hyperhidrosis — Feeling: Good · Site: Pain · Fever · Chills

Free text: Got some excercise walking worked up a good sweat slight chill.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-14
Survey response — days 1–6 daily, dose 2
MedDRA: Ear discomfort — Feeling: Good · Fever · Headache

Free text: A symptom that I get is an earache but it is not an ache. It's more a dull pressure.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Depression, Ear discomfort — Feeling: Good · Muscle or body aches

Free text: Experienced some feeling of unbalance due to loss of depression in ear.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-17
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-31
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-21
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-09
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-08
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-25
Dose 3 — Pfizer-BioNTech
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-01
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-15
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-29
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-06
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-24
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-25
Survey response — 6 months, dose 3
MedDRA: Patient isolation, Self-medication, Viral infection — Feeling: Good · Be unable to do your normal daily activities

Free text: 48 hrs. Virus. Isolated and took Tylenol

MedDRA releases: 2024-11 · check-in free text available
2022-05-16
Dose 4 — Pfizer-BioNTech
2022-05-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-05-19
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-05-20
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-22
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-23
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-30
Health check-in — day 14, dose 4
Feeling: Good

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

Adult check-in
2022-06-13
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-20
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-27
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-17
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-14
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-16
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-10	Moderna
2	2021-03-10	Moderna
3	2021-10-25	Pfizer-BioNTech	No
4	2022-05-16	Pfizer-BioNTech	No

Free text

Release 4 — day 0, dose 1

2021-02-10

Systemic reaction (other): Little lite headedness. Mild indication of Flu Vaccine type conditions.

Release 4 — days 1–6 daily, dose 1

2021-02-11

Systemic reaction (other): Continued indications of Flu Vaccine type conditions

2021-02-12

Systemic reaction (other): Over night mild fever like conditions. This morning took some Tylenol feel fine.

2021-02-13

Systemic reaction (other): Took Tylenol ate a piece of beef. Feel great.

2021-02-14

Systemic reaction (other): It is what it is;

2021-02-15

Systemic reaction (other): The heat does not appeal to certain residents so they turn the furnace off and I keep a constant chill. Then I turn my space heater on.

2021-02-16

Systemic reaction (other): Could be due to the brown guacamole I ate Saturday

Release 4 — day 7, dose 1

2021-02-17

Systemic reaction (other): First day out since receiving the vaccine.

Release 5 — day 0, dose 2

2021-03-10

Systemic reaction (other): Diabetes, Heart Disease, Hypertension, Blood Clot

Release 5 — days 1–6 daily, dose 2

2021-03-11

Systemic reaction (other): Awoke this morning with moderate flulike symptoms. Ate took my meds and vitamins feel fare

2021-03-12

Systemic reaction (other): Got some excercise walking worked up a good sweat slight chill.

2021-03-14

Systemic reaction (other): A symptom that I get is an earache but it is not an ache. It's more a dull pressure.

2021-03-15

Systemic reaction (other): Experienced some feeling of unbalance due to loss of depression in ear.

Release 11 — 6 months, dose 3

2022-04-25

Symptoms: 48 hrs. Virus. Isolated and took Tylenol

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	Patient isolation	·	·	✓
SD	Self-medication	·	·	✓
SD	Viral infection	·	·	✓
SRO	Balance disorder	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Depression	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Ear discomfort	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Hypertension	✓	✓	✓
SRO	Influenza like illness	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Thrombosis	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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