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3A9-13256-05976

2 vaccinations 10 coded responses 26 check-ins 10 free-text entries 2 call cases
Sex
Male
Age at first dose
66+
ZIP prefix
015 / MA
Registered
2021-03-03
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-03-03
    Registered in v-safe
  2. 2021-03-03
    Dose 1 — Moderna
  3. 2021-03-03
    Survey response — day 0, dose 1
    MedDRA: No adverse event — Feeling: Good · Site: Pain · Fatigue or tiredness
    Free text: No Im good thank you
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-03-04
    Survey response — days 1–6 daily, dose 1
    MedDRA: No adverse event — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain
    Free text: No
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-03-05
    Survey response — days 1–6 daily, dose 1
    MedDRA: No adverse event — Feeling: Good · Chills, Joint pains, Fatigue or tiredness
    Free text: None
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-03-06
    Survey response — days 1–6 daily, dose 1
    MedDRA: No adverse event — Feeling: Good
    Free text: None
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-03-07
    Survey response — days 1–6 daily, dose 1
    MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness
    Free text: None
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-03-08
    Survey response — days 1–6 daily, dose 1
    MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness
    Free text: None
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-03-09
    Survey response — days 1–6 daily, dose 1
    MedDRA: Fatigue, Malaise, Peripheral swelling, Rash — Feeling: Fair · Site: Swelling · Fatigue or tiredness, Rash, not including the immediate area around the injection site
    Free text: Had a rash and swelling in both hands for about 2 hours this morning. I also felt out of sorts during this time. I drank two bottles of water and took two Tylenol and the symptoms cleared up and I felt better just fatigued a bit.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-03-10
    Survey response — day 7, dose 1
    MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness
    Free text: None
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-03-17
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-03-24
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  13. 2021-03-31
    Dose 2 — Moderna
  14. 2021-03-31
    Health check-in — day 0, dose 2
    Feeling: Fair · Site: Pain · Fever · Chills, Fatigue or tiredness
    Adult check-in
  15. 2021-04-01
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  16. 2021-04-02
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  17. 2021-04-03
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  18. 2021-04-04
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  19. 2021-04-05
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  20. 2021-04-06
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  21. 2021-04-07
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  22. 2021-04-14
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-04-21
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-04-28
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-05-05
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-05-12
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-06-30
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  28. 2021-09-29
    Survey response — 6 months, dose 2
    MedDRA: Dupuytren's contracture, Malignant melanoma, Rheumatoid arthritis, Squamous cell carcinoma — Feeling: Fair · 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: Melanoma on left forearm, squamous Cell Carcinoma on right trunk, Rheumatoid Arthritis, and Dupuytrens Contracture. All since my last check in.
    MedDRA releases: 2024-11 · check-in free text available
  29. 2021-09-29
    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
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  30. 2021-10-01
  31. 2022-03-31
    Survey response — 12 months, dose 2
    MedDRA: Adverse reaction, Immune system disorder, Malignant melanoma, Nervous system disorder, Soft tissue disorder — 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, Emergency room or emergency department visit, Hospitalization
    Free text: Symptoms: My immune system is over active and attacking my soft tissue. I have been diagnosed with melanoma, And have on going nerve issues. · Healthcare visit (other): All of the above
    MedDRA releases: 2024-11 · check-in free text available
  32. 2022-03-31
    Report sent to call center — 12 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 · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
  33. 2022-04-05
    Call successful
    Participant prefers to complete VAERS report online

Vaccinations

DoseDateManufacturerCo-administered
12021-03-03Moderna
22021-03-31Moderna

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 5 — day 0, dose 1

2021-03-03

Systemic reaction (other): No Im good thank you

Release 5 — days 1–6 daily, dose 1

2021-03-04

Systemic reaction (other): No

2021-03-05

Systemic reaction (other): None

2021-03-06

Systemic reaction (other): None

2021-03-07

Systemic reaction (other): None

2021-03-08

Systemic reaction (other): None

2021-03-09

Systemic reaction (other): Had a rash and swelling in both hands for about 2 hours this morning. I also felt out of sorts during this time. I drank two bottles of water and took two Tylenol and the symptoms cleared up and I felt better just fatigued a bit.

Release 5 — day 7, dose 1

2021-03-10

Systemic reaction (other): None

Release 9 — 6 months, dose 2

2021-09-29

Symptoms: Melanoma on left forearm, squamous Cell Carcinoma on right trunk, Rheumatoid Arthritis, and Dupuytrens Contracture. All since my last check in.

Release 11 — 12 months, dose 2

2022-03-31

Symptoms: My immune system is over active and attacking my soft tissue. I have been diagnosed with melanoma, And have on going nerve issues.
Healthcare visit (other): All of the above

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

FieldPreferred term2021-092023-042024-11
HCVOAdverse reaction · · ✓
SDDupuytren's contracture · · ✓
SDImmune system disorder · · ✓
SDMalignant melanoma · · ✓
SDNervous system disorder · · ✓
SDRheumatoid arthritis · · ✓
SDSoft tissue disorder · · ✓
SDSquamous cell carcinoma · · ✓
SROFatigue ✓ ✓ ✓
SROMalaise ✓ ✓ ✓
SRONo adverse event ✓ ✓ ✓
SROPeripheral swelling ✓ ✓ ✓
SRORash ✓ ✓ ✓

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

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