37J-12056-66050

5 vaccinations 10 coded responses 29 check-ins 10 free-text entries 6 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 956 / CA
Registered: 2021-03-10

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

2021-03-10
Registered in v-safe
2021-03-10
Dose 1 — Moderna
2021-03-10
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-15
Survey response — days 1–6 daily, dose 1
MedDRA: Insomnia — Feeling: Good · Headache, Fatigue or tiredness

Free text: Did not sleep well last night possibly due to time change?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-17
Survey response — day 7, dose 1
MedDRA: Blood glucose increased, Type 2 diabetes mellitus — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Type 2 diabetic... blood glucose running high (200-250) for several days now even with increased oral meds

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Survey response — day 14, dose 1
MedDRA: Blood glucose increased, Neck pain, Pre-existing disease, Spinal pain — Feeling: Fair · 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: Sore neck/upper spine when i turn to the left. Still having issues with high blood glucose (type 2 diabetes)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-01
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-07
Dose 2 — Moderna
2021-04-07
Survey response — day 0, dose 2
MedDRA: Blood glucose increased — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Blood glucose is rising in response to vaccine (t2 diabetic)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-11
Survey response — days 1–6 daily, dose 2
MedDRA: Eye disorder, Vision blurred, Visual impairment — Feeling: Good · Fatigue or tiredness · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Systemic reaction (other): Soarkles and blurriness in right eye... seeing opthamologist on Monday · Healthcare visit (other): For eye problem noted above... Cause still yet TBD

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-14
Survey response — day 7, dose 2
MedDRA: Ocular discomfort, Office visit, Photopsia — Feeling: Fair · Fatigue or tiredness, Nausea · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Flashing lights and discomfort in rt eye · Healthcare visit (other): Opthamologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Report sent to call center — day 7, dose 2
Get care from a doctor or other healthcare professional

no matching call case
2021-04-21
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-28
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-15
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-07-07
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-16
Dose 3 — Moderna
2021-10-06
Survey response — 6 months, dose 2
MedDRA: Nephrolithiasis — 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: Kidney stones

MedDRA releases: 2024-11 · check-in free text available
2021-10-06
Report sent to call center — 6 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)
2021-10-07
Call 1 — Left Voicemail
2021-11-17
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-01-31
Dose 4 — Moderna
2022-02-14
Survey response — 6 months, dose 3
MedDRA: Blood glucose increased — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: High blood glucose

MedDRA releases: 2024-11 · check-in free text available
2022-02-14
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-02-16
Call successful
Does not wish to fill out VAERS report
2022-09-16
Dose 5 — Moderna
2022-10-10
Health check-in — day 21, dose 5
Feeling: Fair

Adult check-in
2022-10-16
Survey response — day 28, dose 5
MedDRA: Arthralgia, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Right and left shoulder pain · Healthcare visit (other): MRI

MedDRA releases: 2024-11 · check-in free text available
2022-10-16
Report sent to call center — day 28, dose 5
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-17
Call 1 — Left Voicemail
2022-10-30
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2022-12-18
Survey response — 3 months, dose 5
MedDRA: Back pain, Fatigue, Muscle spasms, Oropharyngeal pain, Sinus headache — Feeling: Fair · 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: Sinus headache, sore throat, tired, sore back/muscle spasms

MedDRA releases: 2024-11 · check-in free text available
2022-12-18
Report sent to call center — 3 months, dose 5
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)
2022-12-20
Call 2 — Left Voicemail
2022-12-20
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-10	Moderna
2	2021-04-07	Moderna
3	2021-08-16	Moderna	No
4	2022-01-31	Moderna	No
5	2022-09-16	Moderna	No

Call center

6 call center cases

4 successful · 2 unsuccessful

1 check-in flagged for a call with no call center case on record

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-15

Systemic reaction (other): Did not sleep well last night possibly due to time change?

Release 5 — day 7, dose 1

2021-03-17

Systemic reaction (other): Type 2 diabetic... blood glucose running high (200-250) for several days now even with increased oral meds

Release 6 — day 14, dose 1

2021-03-24

Symptoms: Sore neck/upper spine when i turn to the left. Still having issues with high blood glucose (type 2 diabetes)

Release 7 — day 0, dose 2

2021-04-07

Systemic reaction (other): Blood glucose is rising in response to vaccine (t2 diabetic)

Release 7 — days 1–6 daily, dose 2

2021-04-11

Systemic reaction (other): Soarkles and blurriness in right eye... seeing opthamologist on Monday

Healthcare visit (other): For eye problem noted above... Cause still yet TBD

Release 7 — day 7, dose 2

2021-04-14

Systemic reaction (other): Flashing lights and discomfort in rt eye

Healthcare visit (other): Opthamologist

Release 10 — 6 months, dose 2

2021-10-06

Symptoms: Kidney stones

Release 11 — 6 months, dose 3

2022-02-14

Symptoms: High blood glucose

Release 12 — day 28, dose 5

2022-10-16

Symptoms: Right and left shoulder pain

Healthcare visit (other): MRI

Release 12 — 3 months, dose 5

2022-12-18

Symptoms: Sinus headache, sore throat, tired, sore back/muscle spasms

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	Eye disorder	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Unevaluable event	·	·	✓
SD	Arthralgia	·	·	✓
SD	Back pain	·	·	✓
SD	Blood glucose increased	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Neck pain	✓	✓	✓
SD	Nephrolithiasis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Sinus headache	·	·	✓
SD	Spinal pain	✓	✓	✓
SRO	Blood glucose increased	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Ocular discomfort	✓	✓	✓
SRO	Photopsia	✓	✓	✓
SRO	Type 2 diabetes mellitus	✓	✓	✓
SRO	Vision blurred	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

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