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2UB-85053-27505

4 vaccinations 7 coded responses 25 check-ins 6 free-text entries 4 call cases
Sex
Male
Age at first dose
66+
ZIP prefix
100 / NY
Registered
2021-01-27
Relationship
Self
Race
N/A
Ethnicity
N/A

Timeline

  1. 2021-01-27
    Registered in v-safe
  2. 2021-01-27
    Dose 1 — Moderna
  3. 2021-01-27
    Health check-in — day 0, dose 1
    Feeling: Good · None
    Adult check-in
  4. 2021-01-28
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · None
    Adult check-in
  5. 2021-01-29
    Survey response — days 1–6 daily, dose 1
    MedDRA: Headache — Feeling: Good
    Free text: Very slight headache lasting 20 min upon awakening in AM.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-01-30
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-02-01
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-02-03
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-02-10
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  10. 2021-02-17
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-02-24
    Health check-in — day 28, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-02-25
    Dose 2 — Moderna
  13. 2021-02-27
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain, Swelling · Muscle or body aches
    Adult check-in
  14. 2021-03-01
    Survey response — days 1–6 daily, dose 2
    MedDRA: Dyspepsia — Feeling: Good · Site: Swelling
    Free text: Sour stomach
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-03-02
    Survey response — days 1–6 daily, dose 2
    MedDRA: Contusion — Feeling: Good
    Free text: Bad bruise at site of shot but no pain
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-03-03
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  17. 2021-03-04
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  18. 2021-03-11
    Survey response — day 14, dose 2
    MedDRA: Dizziness, Pain in extremity, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional
    Free text: Symptoms: I felt faint yesterday after exercise. I have had pains in my arms. I made an appt with my cardiologist. · Healthcare visit (other): Made an appointment
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-03-11
    Report sent to call center — day 14, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  20. 2021-03-18
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-03-26
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-04-01
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-04-08
    Health check-in — day 42, dose 2
    Feeling: Poor
    Adult check-in
  24. 2021-05-27
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-08-26
    Survey response — 6 months, dose 2
    MedDRA: Atrioventricular block, Coronary arterial stent insertion, Medical procedure — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional
    Free text: Symptoms: I discovered that my heart has a blockage. Hence I had a procedure that ended up with me getting a stent. This had nothing to do with my vaccination. I have some evidence that the condition preceded my vaccination · Healthcare visit (other): Surgical center procedure
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  26. 2021-08-26
    Report sent to call center — 6 months, dose 2
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  27. 2021-08-27
  28. 2021-08-31
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  29. 2021-08-31
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  30. 2021-09-26
    Dose 3 — Moderna
  31. 2022-02-12
    Dose 4 — Pfizer-BioNTech
  32. 2022-02-25
    Survey response — 12 months, dose 2
    MedDRA: Atrioventricular block, Hernia, Pneumonia — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit
    Free text: Heart blockage, lung infection, possible lung cancer. Aldo a hernia in
    MedDRA releases: 2024-11 · check-in free text available
  33. 2022-02-25
    Report sent to call center — 12 months, dose 2
    Get care from a doctor or other healthcare professional
    Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
  34. 2022-03-01
  35. 2022-05-14
    Health check-in — 3 months, dose 4
    Feeling: Good
    Adult check-in
  36. 2022-08-14
    Health check-in — 6 months, dose 4
    Feeling: Good
    Adult check-in
  37. 2023-02-14
    Survey response — 12 months, dose 4
    MedDRA: Bladder disorder, Cardiac disorder, Lung neoplasm malignant, Office visit — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional
    MedDRA releases: 2024-11
  38. 2023-02-14
    Report sent to call center — 12 months, dose 4
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  39. 2023-02-15
  40. 2023-02-15
  41. 2023-02-23
    Call successful
    Participant prefers to complete VAERS report online
  42. 2023-02-23
    Call successful
    Participant prefers to complete VAERS report online

Vaccinations

DoseDateManufacturerCo-administered
12021-01-27Moderna
22021-02-25Moderna
32021-09-26Moderna No
42022-02-12Pfizer-BioNTech No

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-01-29

Systemic reaction (other): Very slight headache lasting 20 min upon awakening in AM.

Release 4 — days 1–6 daily, dose 2

2021-03-01

Systemic reaction (other): Sour stomach

2021-03-02

Systemic reaction (other): Bad bruise at site of shot but no pain

Release 5 — day 14, dose 2

2021-03-11

Symptoms: I felt faint yesterday after exercise. I have had pains in my arms. I made an appt with my cardiologist.
Healthcare visit (other): Made an appointment

Release 9 — 6 months, dose 2

2021-08-26

Symptoms: I discovered that my heart has a blockage. Hence I had a procedure that ended up with me getting a stent. This had nothing to do with my vaccination. I have some evidence that the condition preceded my vaccination
Healthcare visit (other): Surgical center procedure

Release 11 — 12 months, dose 2

2022-02-25

Symptoms: Heart blockage, lung infection, possible lung cancer. Aldo a hernia in

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

FieldPreferred term2021-092023-042024-11
HCVOMedical procedure ✓ · ✓
HCVOOffice visit · · ✓
HCVOUnevaluable event ✓ ✓ ✓
SDAtrioventricular block ✓ · ✓
SDBladder disorder · · ✓
SDCardiac disorder · · ✓
SDCoronary arterial stent insertion ✓ · ✓
SDDizziness ✓ ✓ ✓
SDHernia · · ✓
SDLung neoplasm malignant · · ✓
SDMedical procedure ✓ · ✓
SDPain in extremity ✓ ✓ ✓
SDPneumonia · · ✓
SROContusion ✓ ✓ ✓
SRODyspepsia ✓ ✓ ✓
SROHeadache ✓ ✓ ✓

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

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