2Z7-10884-18220

4 vaccinations 11 coded responses 34 check-ins 10 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 038 / NH
Registered: 2021-05-02

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

2021-04-02
Dose 1 — Moderna
2021-04-30
Dose 2 — Moderna
2021-05-02
Registered in v-safe
2021-05-02
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Hypersomnia — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Slept continuously 20 hours, loss of balance

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Heart rate irregular, Parosmia, Weight decreased — Feeling: Fair · Chills, Headache, Diarrhea

Free text: Change of smell, loss of appetite, loss of weight, irregular heartbeat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-05-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-09
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-21
Survey response — day 21, dose 2
MedDRA: Dyspnoea, Fatigue, Heart rate increased — Feeling: Fair

Free text: Fatigue, out of breath and hi heart rate.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-28
Survey response — day 28, dose 2
MedDRA: Atrial flutter — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Atrial flutter

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Survey response — day 35, dose 2
MedDRA: Anaemia — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Anemia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-11
Survey response — day 42, dose 2
MedDRA: Anaemia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Very anemic

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-31
Survey response — 3 months, dose 2
MedDRA: Hospitalisation, Internal haemorrhage, Transfusion — Feeling: Good · Be unable to do your normal daily activities

Free text: Internal bleeding requiring hospitalization and blood transfusion.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-29
Survey response — 6 months, dose 2
MedDRA: Adverse reaction, Pre-existing disease, Pulmonary congestion, Vertigo — 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: Iin September I had a lot of congestion in my left lung. In October I had a strong reaction to the regular flu shot. Also have more vertigo than is normal for me.

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-02
Call successful
Participant prefers to complete VAERS report online
2021-11-16
Dose 3 — Moderna
2021-11-17
Health check-in — days 1–6 daily, dose 3
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
2021-11-18
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Joint pains

Adult check-in
2021-11-19
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains

Adult check-in
2021-11-21
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-23
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-30
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-07
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-22
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-28
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-15
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-08
Dose 4 — Moderna
2022-04-19
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-04-23
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-30
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-06
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-14
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-20
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-08
Survey response — 3 months, dose 4
MedDRA: Cellulitis — Feeling: Good

Free text: Cellulitis on legs and arms.

MedDRA releases: 2024-11 · check-in free text available
2022-10-09
Survey response — 6 months, dose 4
MedDRA: Pemphigus — 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, Emergency room or emergency department visit

Free text: Developed Pemphigus autoimmune condition.

MedDRA releases: 2024-11 · check-in free text available
2022-10-09
Report sent to call center — 6 months, dose 4
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 · Emergency room or emergency department visit · 1 call case(s)
2022-10-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-09
Survey response — 12 months, dose 4
MedDRA: Pemphigus — Feeling: Good

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-02	Moderna
2	2021-04-30	Moderna
3	2021-11-16	Moderna	No
4	2022-04-08	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 8 — days 1–6 daily, dose 2

2021-05-02

Systemic reaction (other): Slept continuously 20 hours, loss of balance

2021-05-03

Systemic reaction (other): Change of smell, loss of appetite, loss of weight, irregular heartbeat

Release 8 — day 21, dose 2

2021-05-21

Symptoms: Fatigue, out of breath and hi heart rate.

Release 8 — day 28, dose 2

2021-05-28

Symptoms: Atrial flutter

Release 8 — day 35, dose 2

2021-06-04

Symptoms: Anemia

Release 9 — day 42, dose 2

2021-06-11

Symptoms: Very anemic

Release 9 — 3 months, dose 2

2021-07-31

Symptoms: Internal bleeding requiring hospitalization and blood transfusion.

Release 10 — 6 months, dose 2

2021-10-29

Symptoms: Iin September I had a lot of congestion in my left lung. In October I had a strong reaction to the regular flu shot. Also have more vertigo than is normal for me.

Release 12 — 3 months, dose 4

2022-07-08

Symptoms: Cellulitis on legs and arms.

Release 12 — 6 months, dose 4

2022-10-09

Symptoms: Developed Pemphigus autoimmune condition.

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	Adverse reaction	·	·	✓
SD	Anaemia	✓	✓	✓
SD	Atrial flutter	✓	✓	✓
SD	Cellulitis	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Heart rate increased	✓	✓	✓
SD	Hospitalisation	✓	·	✓
SD	Internal haemorrhage	✓	·	✓
SD	Pemphigus	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pulmonary congestion	·	·	✓
SD	Transfusion	✓	·	✓
SD	Vertigo	·	·	✓
SRO	Balance disorder	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Heart rate irregular	✓	✓	✓
SRO	Hypersomnia	✓	✓	✓
SRO	Parosmia	✓	✓	✓
SRO	Weight decreased	✓	✓	✓

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