Z9M-28161-56134

4 vaccinations 10 coded responses 44 check-ins 10 free-text entries 3 call cases

Sex: Male
Age at first dose: 31-35
ZIP prefix: 891 / NV
Registered: 2021-03-16

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-03-12
Dose 1 — Moderna
2021-03-16
Registered in v-safe
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains

Adult check-in
2021-03-19
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-12
Dose 2 — Moderna
2021-04-12
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-04-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-19
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-04-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-03
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-10
Survey response — day 28, dose 2
MedDRA: Chest pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Chest pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-17
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-12
Survey response — 3 months, dose 2
MedDRA: Chest pain — Feeling: Good

Free text: Some chest pain from time to time

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-11
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-01-12
Dose 3 — Moderna
2022-01-12
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · None

Adult check-in
2022-01-13
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-01-14
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches

Adult check-in
2022-01-15
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2022-01-17
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2022-01-18
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2022-01-19
Survey response — day 7, dose 3
MedDRA: Throat tightness — Feeling: Good · Headache

Free text: Throat feels a little tight

MedDRA releases: 2024-11 · check-in free text available
2022-01-26
Survey response — day 14, dose 3
MedDRA: Sensation of foreign body — Feeling: Fair

Free text: Feels like something stuck in throat it went away and it came back

MedDRA releases: 2024-11 · check-in free text available
2022-02-04
Survey response — day 21, dose 3
MedDRA: Oral pruritus, Oropharyngeal pain, SARS-CoV-2 test negative — Feeling: Fair

Free text: Had a sore throat and itchy mouth on and off while tested negative for covid-19 three times. I took 3 tests just to be make sure I didn't have COVID.

MedDRA releases: 2024-11 · check-in free text available
2022-02-11
Survey response — day 28, dose 3
MedDRA: Groin pain, Oropharyngeal pain — Feeling: Fair

Free text: Groin area pain, sore throat

MedDRA releases: 2024-11 · check-in free text available
2022-02-11
Call 1 — Could Not Reach Participant
2022-02-16
Survey response — day 35, dose 3
MedDRA: Office visit, Oropharyngeal pain, Urinary tract infection — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: UTI; sore throat on and off · Healthcare visit (other): Primary care physician

MedDRA releases: 2024-11 · check-in free text available
2022-02-16
Report sent to call center — day 35, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-02-16
Call 2 — Left Voicemail
2022-02-17
Call successful
Does not wish to fill out VAERS report
2022-02-25
Survey response — day 42, dose 3
MedDRA: Oropharyngeal pain, Urticaria — Feeling: Good

Free text: Sire throat, hives

MedDRA releases: 2024-11 · check-in free text available
2022-04-14
Survey response — 3 months, dose 3
MedDRA: Inflammation, Urticaria — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Hives, inflammation

MedDRA releases: 2024-11 · check-in free text available
2022-04-14
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-04-21
Call 1 — Left Voicemail
2022-07-13
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-19
Dose 4 — Moderna
2022-10-19
Health check-in — day 0, dose 4
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches

Adult check-in
2022-10-21
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Itching · None

Adult check-in
2022-10-22
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · None

Adult check-in
2022-10-28
Survey response — day 7, dose 4
MedDRA: Chest pain — Feeling: Fair

Free text: Chest pain

MedDRA releases: 2024-11 · check-in free text available
2022-11-04
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-09
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-23
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-01
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-01-22
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-04-19
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-12	Moderna
2	2021-04-12	Moderna
3	2022-01-12	Moderna	No
4	2022-10-19	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-05-10	Successful	Participant prefers to complete VAERS report online
2022-02-16	Successful 2022-02-17	Does not wish to fill out VAERS report
2022-04-14	Unsuccessful

Free text

Release 8 — day 28, dose 2

2021-05-10

Symptoms: Chest pain

Release 9 — 3 months, dose 2

2021-07-12

Symptoms: Some chest pain from time to time

Release 10 — day 7, dose 3

2022-01-19

Systemic reaction (other): Throat feels a little tight

Release 11 — day 14, dose 3

2022-01-26

Symptoms: Feels like something stuck in throat it went away and it came back

Release 11 — day 21, dose 3

2022-02-04

Symptoms: Had a sore throat and itchy mouth on and off while tested negative for covid-19 three times. I took 3 tests just to be make sure I didn't have COVID.

Release 11 — day 28, dose 3

2022-02-11

Symptoms: Groin area pain, sore throat

Release 11 — day 35, dose 3

2022-02-16

Symptoms: UTI; sore throat on and off

Healthcare visit (other): Primary care physician

Release 11 — day 42, dose 3

2022-02-25

Symptoms: Sire throat, hives

Release 11 — 3 months, dose 3

2022-04-14

Symptoms: Hives, inflammation

Release 12 — day 7, dose 4

2022-10-28

Systemic reaction (other): Chest pain

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
HCVO	Office visit	·	·	✓
SD	Back pain	○	○	○
SD	Chest pain	✓	✓	✓
SD	Groin pain	·	·	✓
SD	Inflammation	·	·	✓
SD	Oral pruritus	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sensation of foreign body	·	·	✓
SD	Urinary tract infection	·	·	✓
SD	Urticaria	·	·	✓
SRO	Chest pain	·	·	✓
SRO	Throat tightness	·	·	✓

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