26N-25182-11984

2 vaccinations 4 coded responses 26 check-ins 4 free-text entries 5 call cases

Sex: Male
Age at first dose: 31-35
ZIP prefix: 900 / CA
Registered: 2021-10-22

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

2021-10-22
Registered in v-safe
2021-10-22
Dose 1 — Moderna
2021-10-22
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-10-23
Health check-in — days 1–6 daily, dose 1
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, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Adult check-in
2021-10-23
Report sent to call center — days 1–6 daily, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-10-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-10-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-10-26
Call successful
Participant prefers to complete VAERS report online
2021-10-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-10-29
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-11-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-11-14
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-11-19
Dose 2 — Moderna
2021-11-19
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-20
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · 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

Adult check-in
2021-11-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-11-22
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache

Adult check-in
2021-11-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-11-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-11-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-11-26
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-12-03
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-12-10
Survey response — day 21, dose 2
MedDRA: Feeling abnormal, Paraesthesia — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Unusual sensations of tingling and weightlessness in the front and left side of the brain 15-20 times per day for the past two weeks.

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-13
Call 2 — Left Voicemail
2021-12-17
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-12-24
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-12-31
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2022-02-19
Survey response — 3 months, dose 2
MedDRA: Herpes simplex, Pre-existing disease — Feeling: Good · 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: Increased HSV-2 outbreaks.

MedDRA releases: 2024-11 · check-in free text available
2022-02-19
Report sent to call center — 3 months, dose 2
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)
2022-02-23
Call 1 — Left Voicemail
2022-05-22
Survey response — 6 months, dose 2
MedDRA: Autoimmune thyroiditis, Herpes simplex, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: 1. New Hashimoto's diagnosis. 2. Continued HSV-2 outbreaks.

MedDRA releases: 2024-11 · check-in free text available
2022-05-22
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-23
Call 1 — Left Voicemail
2022-11-19
Survey response — 12 months, dose 2
MedDRA: 17-hydroxyprogesterone increased, Anti-thyroid antibody increased, COVID-19, Gastric infection, Herpes simplex, Tri-iodothyronine free increased — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: - Stomach infection. - Continuance of HSV-2 breakouts, which started after my COVID-19 infection or vaccination. - High thyroid peroxidase antibody at 42.1 IU/mL. - High Free T3 at 420 pg/dL. - High 17-Alpha-OH progesterone at 184.68 ng/dL.

MedDRA releases: 2024-11 · check-in free text available
2022-11-19
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-11-21
Call 1 — Left Voicemail
2022-11-21
Call 2 — Left Voicemail
2022-11-21
Call 2 — Left Voicemail
2022-11-21
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-10-22	Moderna	No
2	2021-11-19	Moderna	No

Call center

5 call center cases

1 successful · 4 unsuccessful

See the call center timeline

Free text

Release 10 — day 21, dose 2

2021-12-10

Symptoms: Unusual sensations of tingling and weightlessness in the front and left side of the brain 15-20 times per day for the past two weeks.

Release 11 — 3 months, dose 2

2022-02-19

Symptoms: Increased HSV-2 outbreaks.

Release 11 — 6 months, dose 2

2022-05-22

Symptoms: 1. New Hashimoto's diagnosis. 2. Continued HSV-2 outbreaks.

Release 12 — 12 months, dose 2

2022-11-19

Symptoms: - Stomach infection. - Continuance of HSV-2 breakouts, which started after my COVID-19 infection or vaccination. - High thyroid peroxidase antibody at 42.1 IU/mL. - High Free T3 at 420 pg/dL. - High 17-Alpha-OH progesterone at 184.68 ng/dL.

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	17-hydroxyprogesterone increased	·	·	✓
SD	Anti-thyroid antibody increased	·	·	✓
SD	Autoimmune thyroiditis	·	·	✓
SD	COVID-19	·	·	✓
SD	Feeling abnormal	·	·	✓
SD	Gastric infection	·	·	✓
SD	Herpes simplex	·	·	✓
SD	Paraesthesia	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Tri-iodothyronine free increased	·	·	✓

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