2VM-51341-71955

4 vaccinations 5 coded responses 30 check-ins 5 free-text entries 4 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 972 / OR
Registered: 2020-12-29

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

2020-12-29
Registered in v-safe
2020-12-29
Dose 1 — Moderna
2020-12-29
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2020-12-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2020-12-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-05
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-12
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-25
Dose 2 — Moderna
2021-01-26
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Diarrhea

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — day 7, dose 2
Feeling: Good · Site: Redness · Fatigue or tiredness

Adult check-in
2021-02-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-22
Survey response — day 28, dose 2
MedDRA: Pain — Feeling: Fair

Free text: Right aching top of forehand - no discoloration or swelling. No idea if it is related to vaccination.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-26
Survey response — 3 months, dose 2
MedDRA: Headache, Nausea, SARS-CoV-2 test negative, Vomiting — 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

Free text: A daylong headache then nausea and vomiting the following day down to bile which finally resolved after taking an antiemetic. It took the next 3 days to recover. No family members came down with it. Source unknown. COVID-19 test negative.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Report sent to call center — 3 months, 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)
2021-07-26
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-05
Dose 3 — Moderna
2022-01-25
Survey response — 12 months, dose 2
MedDRA: Abdominal discomfort, Diarrhoea, Headache, Medical counselling, Pyrexia, SARS-CoV-2 test — 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

Free text: Symptoms: Prolonged headache, GI upset,fever, diarrhea, NO sinus congestion · Healthcare visit (other): Covid drive through test

MedDRA releases: 2024-11 · check-in free text available
2022-01-25
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 · 1 call case(s)
2022-01-26
Call 1 — Left Voicemail
2022-01-26
Call successful
Participant prefers to complete VAERS report online
2022-01-26
Call successful
Participant prefers to complete VAERS report online
2022-06-03
Dose 4 — Pfizer-BioNTech
2022-06-30
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-07-05
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-07-08
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-15
Survey response — day 42, dose 4
MedDRA: Ear pain, Infection — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Earache probably related to elevation change and subsequent infection

MedDRA releases: 2024-11 · check-in free text available
2022-07-15
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-07-18
Call successful
Participant prefers to complete VAERS report online
2022-09-06
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-12-09
Survey response — 6 months, dose 4
MedDRA: Cough, Respiratory disorder — Feeling: Poor · 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

Free text: Dry cough for 10 days as part of respiratory illness

MedDRA releases: 2024-11 · check-in free text available
2022-12-09
Report sent to call center — 6 months, dose 4
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)
2022-12-14
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-06-03
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-29	Moderna
2	2021-01-25	Moderna
3	2021-11-05	Moderna	No
4	2022-06-03	Pfizer-BioNTech	No

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 4 — day 28, dose 2

2021-02-22

Symptoms: Right aching top of forehand - no discoloration or swelling. No idea if it is related to vaccination.

Release 8 — 3 months, dose 2

2021-04-26

Symptoms: A daylong headache then nausea and vomiting the following day down to bile which finally resolved after taking an antiemetic. It took the next 3 days to recover. No family members came down with it. Source unknown. COVID-19 test negative.

Release 11 — 12 months, dose 2

2022-01-25

Symptoms: Prolonged headache, GI upset,fever, diarrhea, NO sinus congestion

Healthcare visit (other): Covid drive through test

Release 12 — day 42, dose 4

2022-07-15

Symptoms: Earache probably related to elevation change and subsequent infection

Release 12 — 6 months, dose 4

2022-12-09

Symptoms: Dry cough for 10 days as part of respiratory illness

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	SARS-CoV-2 test	·	·	✓
SD	Abdominal discomfort	·	·	✓
SD	Cough	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Ear pain	·	·	✓
SD	Headache	✓	✓	✓
SD	Infection	·	·	✓
SD	Nausea	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	Respiratory disorder	·	·	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Vomiting	✓	✓	✓

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