286-34562-33858

4 vaccinations 13 coded responses 41 check-ins 12 free-text entries 8 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 990 / WA
Registered: 2021-03-10

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

2021-02-11
Dose 1 — Moderna
2021-03-10
Registered in v-safe
2021-03-10
Dose 2 — Moderna
2021-03-10
Survey response — day 0, dose 2
MedDRA: Pre-existing disease — Feeling: Good · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization

Free text: Blood thinners for PE , CAD, Stents, UC symptoms on biological meds

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Report sent to call center — day 0, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Headache, Muscle or body aches

Adult check-in
2021-03-12
Survey response — days 1–6 daily, dose 2
MedDRA: Chest discomfort — Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: Heavy feeling in the chest heart

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Night sweats — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Night sweats

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — day 7, dose 2
MedDRA: Night sweats — Feeling: Fair · Headache, Joint pains, Fatigue or tiredness

Free text: Slight night sweats

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-31
Survey response — day 21, dose 2
MedDRA: Night sweats — Feeling: Good

Free text: Night sweats

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-24
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-09
Survey response — 3 months, dose 2
MedDRA: Office visit, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: My neutrophils were stressed, retook my blood test and they are getting better · Healthcare visit (other): Actual visit with my specialist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-09
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-12
Call 1 — Left Voicemail
2021-08-29
Call 2 — Left Voicemail
2021-09-09
Survey response — 6 months, dose 2
MedDRA: Chest pain, Office visit, Oropharyngeal pain, Respiratory tract congestion, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Constant nasal and congestion, sore throat. Also noticing increase in chest pain. Im seeing my cardiologist for a ultra sound. · Healthcare visit (other): Appointment with specialist

MedDRA releases: 2024-11 · check-in free text available
2021-09-09
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-14
Dose 3 — Moderna
2021-09-14
Health check-in — day 0, dose 3
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-09-15
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-15
Call 1 — Left Voicemail
2021-09-16
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-09-17
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-19
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-20
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-09-21
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-09-28
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-10-05
Survey response — day 21, dose 3
MedDRA: Night sweats, Pyrexia — Feeling: Fair

Free text: Low grade feverish night sweats

MedDRA releases: 2024-11 · check-in free text available
2021-10-12
Survey response — day 28, dose 3
MedDRA: Loss of control of legs, Medical counselling — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: One night I got up and had no control of my right leg. I literally bounce off the wall because I didn't have any mind control of my leg. It also happened when I woke up , eventually my motor control started working. I'm not sure if COVID shot was · Healthcare visit (other): Notified my neurologist

MedDRA releases: 2024-11 · check-in free text available
2021-10-12
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-14
Call successful
Does not wish to fill out VAERS report
2021-10-19
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-10-27
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-14
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-15
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-07
Dose 4 — Moderna
2022-04-11
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2022-04-12
Survey response — days 1–6 daily, dose 4
MedDRA: Office visit — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Doctors appointment

MedDRA releases: 2024-11 · check-in free text available
2022-04-12
Report sent to call center — days 1–6 daily, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-04-13
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-14
Health check-in — day 7, dose 4
Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2022-04-19
Call successful
Participant prefers to complete VAERS report online
2022-04-21
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-29
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-05
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-12
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-05-19
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-07
Survey response — 3 months, dose 4
MedDRA: Headache, Influenza like illness, Medical counselling, Pain, Throat irritation — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Flu like symptoms achy, scratchy throat, headache · Healthcare visit (other): Triage nurse call

MedDRA releases: 2024-11 · check-in free text available
2022-07-07
Report sent to call center — 3 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-07-08
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-08
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-08
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-08
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-06
Survey response — 6 months, dose 4
MedDRA: Cough, Productive cough — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Persistent cough with phlegm

MedDRA releases: 2024-11 · check-in free text available
2022-10-06
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-07
Call 1 — Left Voicemail
2023-04-07
Survey response — 12 months, dose 4
MedDRA: Cough, Office visit, Productive cough — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-07
Report sent to call center — 12 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-11
Call successful
Participant prefers to complete VAERS report online
2023-04-11
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-11	Moderna
2	2021-03-10	Moderna
3	2021-09-14	Moderna	No
4	2022-04-07	Moderna	No

Call center

8 call center cases

8 successful

See the call center timeline

Free text

Release 5 — day 0, dose 2

2021-03-10

Systemic reaction (other): Blood thinners for PE , CAD, Stents, UC symptoms on biological meds

Release 5 — days 1–6 daily, dose 2

2021-03-12

Systemic reaction (other): Heavy feeling in the chest heart

2021-03-16

Systemic reaction (other): Night sweats

Release 5 — day 7, dose 2

2021-03-17

Systemic reaction (other): Slight night sweats

Release 6 — day 21, dose 2

2021-03-31

Symptoms: Night sweats

Release 9 — 3 months, dose 2

2021-06-09

Symptoms: My neutrophils were stressed, retook my blood test and they are getting better

Healthcare visit (other): Actual visit with my specialist

Release 9 — 6 months, dose 2

2021-09-09

Symptoms: Constant nasal and congestion, sore throat. Also noticing increase in chest pain. Im seeing my cardiologist for a ultra sound.

Healthcare visit (other): Appointment with specialist

Release 10 — day 21, dose 3

2021-10-05

Symptoms: Low grade feverish night sweats

Release 10 — day 28, dose 3

2021-10-12

Symptoms: One night I got up and had no control of my right leg. I literally bounce off the wall because I didn't have any mind control of my leg. It also happened when I woke up , eventually my motor control started working. I'm not sure if COVID shot was

Healthcare visit (other): Notified my neurologist

Release 11 — days 1–6 daily, dose 4

2022-04-12

Healthcare visit (other): Doctors appointment

Release 12 — 3 months, dose 4

2022-07-07

Symptoms: Flu like symptoms achy, scratchy throat, headache

Healthcare visit (other): Triage nurse call

Release 12 — 6 months, dose 4

2022-10-06

Symptoms: Persistent cough with phlegm

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	Medical counselling	·	·	✓
HCVO	Office visit	✓	✓	✓
SD	Chest pain	·	·	✓
SD	Cough	·	·	✓
SD	Headache	·	·	✓
SD	Influenza like illness	·	·	✓
SD	Loss of control of legs	·	·	✓
SD	Night sweats	✓	✓	✓
SD	Office visit	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Productive cough	·	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Throat irritation	·	·	✓
SD	Unevaluable event	✓	✓	✓
SRO	Chest discomfort	✓	✓	✓
SRO	Night sweats	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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