ZA4-17971-69766

2 vaccinations 9 coded responses 12 check-ins 9 free-text entries 0 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 373 / TN
Registered: 2021-05-07

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

2021-05-06
Dose 1 — Moderna
2021-05-07
Registered in v-safe
2021-05-07
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-08
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Chest paint off and on

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Chills, Joint pains, Nausea, Vomiting, Abdominal pain · Be unable to work

Adult check-in
2021-05-10
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Dyspnoea, Hyperhidrosis — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to do your normal daily activities

Free text: Dizzy and out of breath and sweating hard at 57 degree temps

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling hot, Hyperhidrosis — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to do your normal daily activities

Free text: Hot and sweating

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Survey response — days 1–6 daily, dose 1
MedDRA: Hyperhidrosis — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Nausea · Be unable to do your normal daily activities

Free text: Sweating heavily

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Survey response — day 7, dose 1
MedDRA: Dizziness, Dyspnoea, Oropharyngeal pain — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Dizzy , short of breath, sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Survey response — day 14, dose 1
MedDRA: Cough, Decreased appetite, Dizziness, Dyspnoea, Rhinorrhoea, Sinus congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: 1.Severe sinus congestion and sometime runny nose.2.bad dry cough then with mucus and coughing to the point of feeling like you are going to Passout. 3.Dizziness.4. Short of breath.5. Loss of appetite.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Survey response — day 21, dose 1
MedDRA: Cough, Dizziness, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Dizziness. Vomiting. Cough.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-07
Survey response — 3 months, dose 1
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Still feeling extremely tired.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-04
Health check-in — 6 months, dose 1
Feeling: Fair

Adult check-in
2022-05-06
Dose 2 — Moderna
2022-05-06
Survey response — 12 months, dose 1
MedDRA: Blood pressure increased, Dizziness, Emergency care, Impaired work ability, Migraine — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: My bp shot up, then I became dizzy got a migraine and have felt the same every since then and have been in the hospital for it. I haven't been able to work since then.

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-06	Moderna
2	2022-05-06	Moderna	No

Free text

Release 8 — days 1–6 daily, dose 1

2021-05-08

Systemic reaction (other): Chest paint off and on

2021-05-10

Systemic reaction (other): Dizzy and out of breath and sweating hard at 57 degree temps

2021-05-11

Systemic reaction (other): Hot and sweating

2021-05-12

Systemic reaction (other): Sweating heavily

Release 8 — day 7, dose 1

2021-05-15

Systemic reaction (other): Dizzy , short of breath, sore throat

Release 8 — day 14, dose 1

2021-05-20

Symptoms: 1.Severe sinus congestion and sometime runny nose.2.bad dry cough then with mucus and coughing to the point of feeling like you are going to Passout. 3.Dizziness.4. Short of breath.5. Loss of appetite.

Release 8 — day 21, dose 1

2021-05-27

Symptoms: Dizziness. Vomiting. Cough.

Release 9 — 3 months, dose 1

2021-08-07

Symptoms: Still feeling extremely tired.

Release 11 — 12 months, dose 1

2022-05-06

Symptoms: My bp shot up, then I became dizzy got a migraine and have felt the same every since then and have been in the hospital for it. I haven't been able to work since then.

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	Blood pressure increased	·	·	✓
SD	Cough	✓	✓	✓
SD	Decreased appetite	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Emergency care	·	·	✓
SD	Fatigue	✓	·	✓
SD	Impaired work ability	·	·	✓
SD	Migraine	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Sinus congestion	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓

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