38V-19956-93349

4 vaccinations 9 coded responses 48 check-ins 8 free-text entries 3 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 921 / CA
Registered: 2021-02-02

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

2021-01-22
Dose 1 — Moderna
2021-02-02
Registered in v-safe
2021-02-02
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-02-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-14
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-19
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-20
Dose 2 — Moderna
2021-02-20
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-27
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-06
Survey response — day 14, dose 2
MedDRA: Gastrointestinal pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Gut pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-20
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-27
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-03
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-23
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-26
Dose 3 — Moderna
2021-10-26
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work or attend school

Adult check-in
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Medical counselling — Feeling: Fair · Site: Pain · Chills, Headache, 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 · Telehealth, virtual health, or email health consultation

Free text: Called and spoke to doctor - he said 5 doctors including him had similar side effects for 2-3 weeks. Said to rest - drink fluids and advil.

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Report sent to call center — days 1–6 daily, 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)
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Muscle twitching — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Sporadic Muscle Twitching - not painful - all parts of the body

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-11-02
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-02
Call 1 — Could Not Reach Participant
2021-11-05
Call 2 — Left Voicemail
2021-11-08
Call 3 — Could Not Reach Participant
2021-11-10
Call successful
Participant prefers to complete VAERS report online
2021-11-11
Survey response — day 14, dose 3
MedDRA: Chills, Diarrhoea, Office visit, Pyrexia, SARS-CoV-2 test negative — 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 · Outpatient clinic or urgent care clinic visit

Free text: Severe Diarrhea from Sunday to current - severe chills and fever of 101. Dr. Thought I might have Covid and took a PCR test and was negative. Dr. Said it could be reaction booster shot.

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Report sent to call center — day 14, 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-16
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-19
Call 2 — Left Voicemail
2021-11-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-07
Survey response — day 42, dose 3
MedDRA: Tinnitus — Feeling: Fair

Free text: Ear Tinnitus - very bad out of nowhere since last week.

MedDRA releases: 2024-11 · check-in free text available
2022-01-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-26
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-05-25
Dose 4 — Pfizer-BioNTech
2022-05-25
Health check-in — day 0, dose 4
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-05-26
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Chills, 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
2022-05-27
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness, Nausea · Be unable to work or attend school

Adult check-in
2022-05-28
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fever · Chills, Fatigue or tiredness

Adult check-in
2022-05-29
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-05-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-05-31
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-06-03
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-06-08
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-16
Survey response — day 21, dose 4
MedDRA: Arthralgia — Feeling: Fair

Free text: Joint pain

MedDRA releases: 2024-11 · check-in free text available
2022-06-23
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-07-01
Survey response — day 35, dose 4
MedDRA: Body temperature decreased, Chills, Cough, Diarrhoea, Headache, Lethargy, Office visit, Oropharyngeal pain, Pain, Pyrexia, SARS-CoV-2 test negative — 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 · Outpatient clinic or urgent care clinic visit

Free text: Body Aches - Diarreah for a week. Lethargy. Slight headache. Low grade fever and low temperature of 95.9. Chills. Weird sore throat. Slight cough at onset Went to Dr. and he thought I had Covid. PCR test came back negative today. 5 antigen tests neg.

MedDRA releases: 2024-11 · check-in free text available
2022-07-01
Report sent to call center — day 35, 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-07-05
Call 1 — Left Voicemail
2022-07-05
Call 1 — Left Voicemail
2022-07-06
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-06
Call successful
Participant prefers to complete VAERS report online
2022-07-06
Call successful
Participant prefers to complete VAERS report online
2022-11-23
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-25
Survey response — 12 months, dose 4
MedDRA: Adverse reaction, Pre-existing disease — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Moderna
2	2021-02-20	Moderna
3	2021-10-26	Moderna	No
4	2022-05-25	Pfizer-BioNTech	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-22

Systemic reaction (other): Dizziness

Release 5 — day 14, dose 2

2021-03-06

Symptoms: Gut pain

Release 10 — days 1–6 daily, dose 3

2021-10-30

Healthcare visit (other): Called and spoke to doctor - he said 5 doctors including him had similar side effects for 2-3 weeks. Said to rest - drink fluids and advil.

2021-10-31

Systemic reaction (other): Sporadic Muscle Twitching - not painful - all parts of the body

Release 10 — day 14, dose 3

2021-11-11

Symptoms: Severe Diarrhea from Sunday to current - severe chills and fever of 101. Dr. Thought I might have Covid and took a PCR test and was negative. Dr. Said it could be reaction booster shot.

Release 10 — day 42, dose 3

2021-12-07

Symptoms: Ear Tinnitus - very bad out of nowhere since last week.

Release 12 — day 21, dose 4

2022-06-16

Symptoms: Joint pain

Release 12 — day 35, dose 4

2022-07-01

Symptoms: Body Aches - Diarreah for a week. Lethargy. Slight headache. Low grade fever and low temperature of 95.9. Chills. Weird sore throat. Slight cough at onset Went to Dr. and he thought I had Covid. PCR test came back negative today. 5 antigen tests neg. cut off by CDC

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	·	·	✓
SD	Adverse reaction	·	·	✓
SD	Arthralgia	·	·	✓
SD	Body temperature decreased	·	·	✓
SD	Chills	·	·	✓
SD	Cough	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Gastrointestinal pain	✓	✓	✓
SD	Headache	·	·	✓
SD	Lethargy	·	·	✓
SD	Office visit	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Tinnitus	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Muscle twitching	·	·	✓

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