ZVL-11779-18978

3 vaccinations 8 coded responses 11 check-ins 8 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 891 / NV
Registered: 2021-03-24

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-18
Dose 1 — Moderna
2021-03-18
Dose 2 — Moderna
2021-03-24
Registered in v-safe
2021-03-24
Survey response — days 1–6 daily, dose 2
MedDRA: Amnesia, Breath odour — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Oxygen 93 short term memory loss bad breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — day 7, dose 2
MedDRA: Breath odour, Hypertension — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work

Free text: Bad breath high blood pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-08
Survey response — day 21, dose 2
MedDRA: Amnesia, Anxiety, Blood pressure decreased, Depression — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Lower blood pressure, as well as short term memory loss .. high anxiety and some low grade depression

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Survey response — day 28, dose 2
MedDRA: Cough, Fatigue, Gastrointestinal disorder, Hypertension, Oxygen saturation decreased — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Upper GI ... exhausted and high blood pressure.. lower oxygen levels coughing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-01
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-09-19
Survey response — 6 months, dose 2
MedDRA: Amnesia, Confusional state, Gastrointestinal disorder, Gastrointestinal pain, Vertigo — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Vertigo/ Short Term memory loss/ confusion/ upper GI pain and problems

MedDRA releases: 2024-11 · check-in free text available
2021-09-26
Dose 3 — Moderna
2021-10-27
Survey response — day 28, dose 3
MedDRA: Anxiety, Asthenia, Brain fog — Feeling: Fair · Be unable to do your normal daily activities

Free text: No energy and Brain Fog high anxiety

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Survey response — day 35, dose 3
MedDRA: Anxiety, Brain fog, Clumsiness, Heart rate decreased, Mania, SARS-CoV-2 test — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Brian Fog, anxiety, clumsy, manic , low heart rate .. · Healthcare visit (other): COVID Test

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Report sent to call center — day 35, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-03
Call 1 — Left Voicemail
2021-11-04
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-07
Survey response — day 42, dose 3
MedDRA: Fatigue, Heart rate decreased, Hypopnoea — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Exhausted , shallow breathing , 42 pulse rate,

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-12
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-18	Moderna
2	2021-03-18	Moderna
3	2021-09-26	Moderna	No

Call center

2 call center cases

1 successful · 1 unsuccessful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-24

Systemic reaction (other): Oxygen 93 short term memory loss bad breath

Release 6 — day 7, dose 2

2021-03-26

Systemic reaction (other): Bad breath high blood pressure

Release 7 — day 21, dose 2

2021-04-08

Symptoms: Lower blood pressure, as well as short term memory loss .. high anxiety and some low grade depression

Release 7 — day 28, dose 2

2021-04-17

Symptoms: Upper GI ... exhausted and high blood pressure.. lower oxygen levels coughing

Release 9 — 6 months, dose 2

2021-09-19

Symptoms: Vertigo/ Short Term memory loss/ confusion/ upper GI pain and problems

Release 10 — day 28, dose 3

2021-10-27

Symptoms: No energy and Brain Fog high anxiety

Release 10 — day 35, dose 3

2021-10-31

Symptoms: Brian Fog, anxiety, clumsy, manic , low heart rate ..

Healthcare visit (other): COVID Test

Release 10 — day 42, dose 3

2021-11-07

Symptoms: Exhausted , shallow breathing , 42 pulse rate,

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	SARS-CoV-2 test	·	·	✓
SD	Amnesia	✓	✓	✓
SD	Anxiety	✓	✓	✓
SD	Asthenia	·	·	✓
SD	Blood pressure decreased	✓	✓	✓
SD	Brain fog	·	·	✓
SD	Clumsiness	·	·	✓
SD	Confusional state	·	·	✓
SD	Cough	✓	✓	✓
SD	Depression	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Gastrointestinal pain	·	·	✓
SD	Heart rate decreased	·	·	✓
SD	Hypertension	✓	✓	✓
SD	Hypopnoea	·	·	✓
SD	Mania	·	·	✓
SD	Oxygen saturation decreased	✓	✓	✓
SD	Vertigo	·	·	✓
SRO	Amnesia	✓	✓	✓
SRO	Breath odour	✓	✓	✓
SRO	Hypertension	✓	✓	✓

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