2Z4-44091-23040

5 vaccinations 9 coded responses 34 check-ins 9 free-text entries 8 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 981 / WA
Registered: 2021-02-11

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Possible VAERS report

VAERS ID	Confidence	Score	Runner-up	Shared symptoms	Dose	State	VAERS vaccinated / onset / received	Call case
2463464 (opens in a new window)	high	10 / 11	3	3 of 11 VAERS symptoms	same dose (5)	WA matches	2022-09-13 / 2022-09-19 / 2022-09-28 received 20 days before the last call	case 1095039

From the VAERS matching of call center cases (loader/vaers_match_*). Only the best match is shown, and only if it scores 8 or more out of 11. The score adds up timing (VAERS received soon after the call center contact), dose and shared symptoms; state only breaks ties. Confidence is high when the score is 8+ and at least 3 points ahead of the runner-up, medium when 5+ and 2 ahead, otherwise low. A match is a likely link, not a confirmed one.

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-01-19
Dose 1 — Moderna
2021-02-11
Registered in v-safe
2021-02-11
Survey response — day 21, dose 1
MedDRA: Seizure — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: New onset of seizure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-12
Dose 2 — Moderna
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2021-02-20
Health check-in — day 7, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-26
Survey response — day 14, dose 2
MedDRA: Fatigue, Myalgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue, muscle pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-16
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-20
Call 1 — Left Voicemail
2021-10-25
Dose 3 — Moderna
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-11-02
Health check-in — day 7, dose 3
Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-15
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-22
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-11-29
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-06
Survey response — day 42, dose 3
MedDRA: Muscle rupture, Myalgia — 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, Outpatient clinic or urgent care clinic visit

Free text: Inexplicable muscle tears in leg. Extreme pain.

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Report sent to call center — day 42, 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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-08
Call 1 — Left Voicemail
2022-01-24
Survey response — 3 months, dose 3
MedDRA: Polymyalgia rheumatica — Feeling: Poor · 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: Polymyalgia rheumatica

MedDRA releases: 2024-11 · check-in free text available
2022-01-24
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-26
Call 1 — Left Voicemail
2022-01-27
Call successful
Does not wish to fill out VAERS report
2022-03-01
Dose 4 — Moderna
2022-04-27
Survey response — 6 months, dose 3
MedDRA: Atrial fibrillation — Feeling: Poor · 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

Free text: Greatly increased afib

MedDRA releases: 2024-11 · check-in free text available
2022-04-27
Report sent to call center — 6 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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-29
Call 1 — Left Voicemail
2022-06-01
Call 2 — Left Voicemail
2022-06-01
Call successful
Other
2022-09-13
Dose 5 — Moderna
Co-administered: Tetanus
2022-09-13
Health check-in — day 0, dose 5
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-16
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-09-17
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-09-18
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-09-22
Survey response — day 7, dose 5
MedDRA: Blood pressure decreased, Cardiac disorder, Hospitalisation — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Heart admission to Hospital. Blood pressure collapse

MedDRA releases: 2024-11 · check-in free text available
2022-09-22
Report sent to call center — day 7, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-09-22
Call 1 — Left Voicemail
2022-09-27
Survey response — day 14, dose 5
MedDRA: Blood pressure immeasurable, Cardiac tamponade, Emergency care, Hospitalisation, Near death experience — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Pericardial tamponade, near death , complete loss of blood pressure, 6 days emergency hospitalization

MedDRA releases: 2024-11 · check-in free text available
2022-09-27
Report sent to call center — day 14, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-09-28
Call 2 — Requested Callback
2022-09-28
Call 1 — Requested Callback
2022-09-28
Callback requested for
05:30PM ET
2022-09-28
Call successful
Completed over the phone
2022-09-28
Call successful
Completed over the phone
2022-10-04
Survey response — day 21, dose 5
MedDRA: Atrial fibrillation, Cardiac tamponade, Unevaluable event — Feeling: Poor · 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, Hospitalization

Free text: Symptoms: After pericardial tamponade I have had significantly increased AFIB which will require a hearing procedure later this week. · Healthcare visit (other): Hospital procedure scheduled for Thursday

MedDRA releases: 2024-11 · check-in free text available
2022-10-04
Report sent to call center — day 21, dose 5
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 · Hospitalization · 1 call case(s)
2022-10-05
Call 1 — Left Voicemail
2022-10-14
Survey response — day 28, dose 5
MedDRA: Cardiac tamponade, Gastrointestinal infection, Hospitalisation — 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 · Emergency room or emergency department visit, Hospitalization

Free text: 7 day hospitalization for intestinal infection. This was one week after 6 day hospitalization for near fatal pericardial tamponade ( already reported) which was 7 or 8 days after bivalent Moderna booster.

MedDRA releases: 2024-11 · check-in free text available
2022-10-14
Report sent to call center — day 28, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-10-17
Call 2 — Left Voicemail
2022-10-17
Call 1 — Left Voicemail
2022-10-18
Call successful
Reported to VAERS during previous contact from GDIT
2022-10-18
Call successful
Reported to VAERS during previous contact from GDIT
2022-10-21
Health check-in — day 35, dose 5
Feeling: Poor

Adult check-in
2022-10-26
Health check-in — day 42, dose 5
Feeling: Poor

Adult check-in
2022-12-18
Health check-in — 3 months, dose 5
Feeling: Fair

Adult check-in
2023-03-14
Health check-in — 6 months, dose 5
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-19	Moderna
2	2021-02-12	Moderna
3	2021-10-25	Moderna	No
4	2022-03-01	Moderna	No
5	2022-09-13	Moderna	Tetanus

Call center

8 call center cases

8 successful

VAERS report filed, before or during a call: 4

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 4 — day 21, dose 1

2021-02-11

Symptoms: New onset of seizure

Release 4 — day 14, dose 2

2021-02-26

Symptoms: Fatigue, muscle pain

Release 10 — day 42, dose 3

2021-12-06

Symptoms: Inexplicable muscle tears in leg. Extreme pain.

Release 11 — 3 months, dose 3

2022-01-24

Symptoms: Polymyalgia rheumatica

Release 11 — 6 months, dose 3

2022-04-27

Symptoms: Greatly increased afib

Release 12 — day 7, dose 5

2022-09-22

Systemic reaction (other): Heart admission to Hospital. Blood pressure collapse

Release 12 — day 14, dose 5

2022-09-27

Symptoms: Pericardial tamponade, near death , complete loss of blood pressure, 6 days emergency hospitalization

Release 12 — day 21, dose 5

2022-10-04

Symptoms: After pericardial tamponade I have had significantly increased AFIB which will require a hearing procedure later this week.

Healthcare visit (other): Hospital procedure scheduled for Thursday

Release 12 — day 28, dose 5

2022-10-14

Symptoms: 7 day hospitalization for intestinal infection. This was one week after 6 day hospitalization for near fatal pericardial tamponade ( already reported) which was 7 or 8 days after bivalent Moderna booster.

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	Unevaluable event	·	·	✓
SD	Atrial fibrillation	·	·	✓
SD	Blood pressure immeasurable	·	·	✓
SD	Cardiac tamponade	·	·	✓
SD	Emergency care	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Gastrointestinal infection	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Muscle rupture	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Near death experience	·	·	✓
SD	Polymyalgia rheumatica	·	·	✓
SD	Seizure	✓	✓	✓
SRO	Blood pressure decreased	·	·	✓
SRO	Cardiac disorder	·	·	✓
SRO	Hospitalisation	·	·	✓

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