ZGJ-26778-01300

3 vaccinations 6 coded responses 26 check-ins 6 free-text entries 0 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 980 / WA
Registered: 2021-03-19

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

2021-03-19
Registered in v-safe
2021-03-19
Dose 1 — Moderna
2021-03-19
Survey response — day 0, dose 1
MedDRA: Obstructive sleep apnoea syndrome, Pre-existing disease, Tricuspid valve disease — Feeling: Good · Fatigue or tiredness

Free text: Obstructive Lung Disease, Tricuspid Valve disease

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain, Itching · Fever · Headache, Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-28
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-04-02
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-04-09
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-13
Dose 2 — Moderna
2021-04-13
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Itching · Fatigue or tiredness

Adult check-in
2021-04-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-04-19
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-04-20
Health check-in — day 7, dose 2
Feeling: Fair · Site: Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-27
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-04
Survey response — day 21, dose 2
MedDRA: Asthenia, Fatigue, Herpes zoster, Nausea — Feeling: Poor

Free text: My shingles pain has increased to an uncomfortable level. I feel nauseous and weak, tired.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-14
Survey response — 3 months, dose 2
MedDRA: Neuralgia — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: The shingles neuralgia pain near has returned and is not as responsive to the DRG Implant II Generator/pain management device. Does the Moderna Vaccine activate the body's auto immune response after receiving the last Shingles Vaccine? Just wondering

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-14
Survey response — 6 months, dose 2
MedDRA: Cough, Dyspnoea, Exposure to SARS-CoV-2, Retching — Feeling: Poor · Be unable to do your normal daily activities

Free text: Coughing, gagging, shortness of breath, and exposure to Covid 19

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Dose 3 — Moderna
2021-11-11
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-13
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Influenza like illness, Nasopharyngitis — Feeling: Fair · Site: Pain · Be unable to work or attend school

Free text: bad cough & cold/flu like symptoms

MedDRA releases: 2024-11 · check-in free text available
2021-11-14
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2021-11-17
Survey response — day 7, dose 3
MedDRA: Ageusia, Anosmia, Dyspnoea — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: cant breath easily, taste or smell

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-19	Moderna
2	2021-04-13	Moderna
3	2021-11-08	Moderna	No

Free text

Release 5 — day 0, dose 1

2021-03-19

Systemic reaction (other): Obstructive Lung Disease, Tricuspid Valve disease

Release 8 — day 21, dose 2

2021-05-04

Symptoms: My shingles pain has increased to an uncomfortable level. I feel nauseous and weak, tired.

Release 9 — 3 months, dose 2

2021-07-14

Symptoms: The shingles neuralgia pain near has returned and is not as responsive to the DRG Implant II Generator/pain management device. Does the Moderna Vaccine activate the body's auto immune response after receiving the last Shingles Vaccine? Just wondering cut off by CDC

Release 10 — 6 months, dose 2

2021-10-14

Symptoms: Coughing, gagging, shortness of breath, and exposure to Covid 19

Release 10 — days 1–6 daily, dose 3

2021-11-13

Systemic reaction (other): bad cough & cold/flu like symptoms

Release 10 — day 7, dose 3

2021-11-17

Systemic reaction (other): cant breath easily, taste or smell

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	Dyspnoea	·	·	✓
SD	Exposure to SARS-CoV-2	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Herpes zoster	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Neuralgia	✓	✓	✓
SD	Retching	·	·	✓
SD	Unevaluable event	○	○	○
SRO	Ageusia	·	·	✓
SRO	Anosmia	·	·	✓
SRO	Cough	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Influenza like illness	·	·	✓
SRO	Nasopharyngitis	·	·	✓
SRO	Obstructive sleep apnoea syndrome	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Tricuspid valve disease	✓	✓	✓

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