2WE-10923-78924

3 vaccinations 6 coded responses 28 check-ins 5 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 381 / TN
Registered: 2021-01-19

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

2021-01-18
Dose 1 — Moderna
2021-01-19
Registered in v-safe
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Diverticulitis, Pre-existing disease — Feeling: Good · Site: Pain · Chills, Abdominal pain

Free text: Im reasonably sure I am having a mild case of diverticulitis unrelated to the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-10
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-15
Dose 2 — Moderna
2021-02-15
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-02-17
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain — Feeling: Fair · Site: Pain

Free text: Ear ache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-22
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-22
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-17
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-16
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-15
Survey response — 12 months, dose 2
MedDRA: Nasopharyngitis, Oropharyngeal pain, Respiratory tract congestion — Feeling: Good · Be unable to work or attend school, 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: Cold, chest congestion, sore throat lasting approximately 8-10 days

MedDRA releases: 2024-11 · check-in free text available
2022-02-15
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · 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)
2022-02-17
Call 1 — Left Voicemail
2022-02-21
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-09-11
Dose 3 — Moderna
2022-09-29
Survey response — day 14, dose 3
MedDRA: Nasopharyngitis, Pain, Respiratory disorder, Respiratory tract congestion — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: I had a severe upper respiratory event that lasted 7-9 days. Cold, body aches, congestion etc.

MedDRA releases: 2024-11 · check-in free text available
2022-09-29
Report sent to call center — day 14, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-02
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-10-09
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-12-11
Survey response — 3 months, dose 3
MedDRA: Asthenia, Feeling hot, Nasopharyngitis, Oropharyngeal pain — Feeling: Good · 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: Had a cold, slight sore throat, felt weak and slightly feverish although no elevated temperature. Symptoms last approximately two weeks. After 10th day my doctor prescribed a medrol dose pak and antibiotics for 5 days (Levaquin). tested neg twice.

MedDRA releases: 2024-11 · check-in free text available
2022-12-11
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2023-03-12
Survey response — 6 months, dose 3
MedDRA: Fatigue, Nasopharyngitis, Respiratory tract congestion — 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

MedDRA releases: 2024-11
2023-03-12
Report sent to call center — 6 months, dose 3
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)
2023-03-13
Call successful
Completed over the phone
2023-03-13
Call successful
Completed over the phone
2023-03-13
Call successful
Completed over the phone

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-18	Moderna
2	2021-02-15	Moderna
3	2022-09-11	Moderna	No

Call center

4 call center cases

4 successful

VAERS report filed, before or during a call: 3

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-22

Systemic reaction (other): Im reasonably sure I am having a mild case of diverticulitis unrelated to the vaccine.

Release 4 — days 1–6 daily, dose 2

2021-02-17

Systemic reaction (other): Ear ache

Release 11 — 12 months, dose 2

2022-02-15

Symptoms: Cold, chest congestion, sore throat lasting approximately 8-10 days

Release 12 — day 14, dose 3

2022-09-29

Symptoms: I had a severe upper respiratory event that lasted 7-9 days. Cold, body aches, congestion etc.

Release 12 — 3 months, dose 3

2022-12-11

Symptoms: Had a cold, slight sore throat, felt weak and slightly feverish although no elevated temperature. Symptoms last approximately two weeks. After 10th day my doctor prescribed a medrol dose pak and antibiotics for 5 days (Levaquin). tested neg twice.

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	Asthenia	·	·	✓
SD	Fatigue	·	·	✓
SD	Feeling hot	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Respiratory disorder	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SRO	Diverticulitis	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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