ZQX-10478-90586

5 vaccinations 9 coded responses 47 check-ins 8 free-text entries 0 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 598 / MT
Registered: 2021-03-16

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

2021-03-03
Dose 1 — Moderna
2021-03-16
Registered in v-safe
2021-03-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-31
Dose 2 — Moderna
2021-03-31
Health check-in — day 0, dose 2
Feeling: Good · Chills, Fatigue or tiredness

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · None

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · None

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · Fatigue or tiredness

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Fatigue or tiredness

Adult check-in
2021-04-07
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness

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

Adult check-in
2021-04-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-29
Survey response — day 28, dose 2
MedDRA: Headache, Neck pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Severe ongoing headache and neck pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-12
Survey response — day 42, dose 2
MedDRA: Injection site pain, Injection site swelling, Skin tightness — Feeling: Good

Free text: Swelling, some pain and tightness around the vaccine shot site. I got both shots on my right arm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-03
Survey response — 3 months, dose 2
MedDRA: Dermatitis allergic — Feeling: Good

Free text: Persistent allergic rash.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-29
Survey response — 6 months, dose 2
MedDRA: Pre-existing disease, Rash — Feeling: Fair · Be unable to do your normal daily activities

Free text: Worsening chronic rash on chest and trunk area.

MedDRA releases: 2024-11 · check-in free text available
2021-10-27
Dose 3 — Moderna
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Rash — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site

Free text: The rash has been persistent since mid March after my first dose. Numerous prescription topical creams and still the rash remains. Not sure if it is from the vaccine or not.

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · Rash, not including the immediate area around the injection site

Adult check-in
2021-11-03
Health check-in — day 7, dose 3
Feeling: Fair · Rash, not including the immediate area around the injection site

Adult check-in
2021-11-10
Survey response — day 14, dose 3
MedDRA: Rash — Feeling: Good

Free text: Rash still present.

MedDRA releases: 2024-11 · check-in free text available
2021-11-17
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-24
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-10
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-27
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-11
Dose 4 — Moderna
2022-04-16
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Swelling · Joint pains, Rash, not including the immediate area around the injection site

Adult check-in
2022-04-17
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2022-04-18
Health check-in — day 7, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2022-04-27
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-02
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-16
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-23
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-11
Survey response — 3 months, dose 4
MedDRA: Arrhythmia — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Erratic heart rhythms

MedDRA releases: 2024-11 · check-in free text available
2022-10-10
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2022-11-03
Dose 5 — Moderna
2022-11-03
Health check-in — day 0, dose 5
Feeling: Good · None

Adult check-in
2022-11-04
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2022-11-05
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2022-11-08
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Swelling, Itching · Rash, not including the immediate area around the injection site

Adult check-in
2022-11-12
Health check-in — day 7, dose 5
Feeling: Fair · Site: Pain, Swelling, Itching · Rash, not including the immediate area around the injection site

Adult check-in
2022-11-24
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-12-01
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-12-08
Survey response — day 35, dose 5
MedDRA: Injection site rash — Feeling: Fair

Free text: Rash has come back around injection site.

MedDRA releases: 2024-11 · check-in free text available
2022-12-15
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-02-02
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-05-04
Survey response — 6 months, dose 5
MedDRA: Heart rate irregular, Rash — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-03	Moderna
2	2021-03-31	Moderna
3	2021-10-27	Moderna	No
4	2022-04-11	Moderna	No
5	2022-11-03	Moderna	No

Free text

Release 8 — day 28, dose 2

2021-04-29

Symptoms: Severe ongoing headache and neck pain.

Release 8 — day 42, dose 2

2021-05-12

Symptoms: Swelling, some pain and tightness around the vaccine shot site. I got both shots on my right arm.

Release 9 — 3 months, dose 2

2021-07-03

Symptoms: Persistent allergic rash.

Release 9 — 6 months, dose 2

2021-09-29

Symptoms: Worsening chronic rash on chest and trunk area.

Release 10 — days 1–6 daily, dose 3

2021-10-31

Systemic reaction (other): The rash has been persistent since mid March after my first dose. Numerous prescription topical creams and still the rash remains. Not sure if it is from the vaccine or not.

Release 10 — day 14, dose 3

2021-11-10

Symptoms: Rash still present.

Release 12 — 3 months, dose 4

2022-07-11

Symptoms: Erratic heart rhythms

Release 12 — day 35, dose 5

2022-12-08

Symptoms: Rash has come back around injection site.

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	Arrhythmia	·	·	✓
SD	Dermatitis allergic	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Heart rate irregular	·	·	✓
SD	Injection site pain	✓	✓	✓
SD	Injection site rash	·	·	✓
SD	Injection site swelling	✓	✓	✓
SD	Neck pain	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Rash	·	·	✓
SD	Skin tightness	✓	✓	✓
SRO	Rash	·	·	✓

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