3AQ-31489-75010

2 vaccinations 14 coded responses 21 check-ins 14 free-text entries 9 call cases

Sex: Male
Age at first dose: 46-50
ZIP prefix: 115 / NY
Registered: 2021-09-23

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

2021-09-23
Registered in v-safe
2021-09-23
Dose 1 — Moderna
2021-09-23
Survey response — day 0, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Swelling · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2024-11 · check-in free text available
2021-09-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Joint pains, Fatigue or tiredness, Diarrhea · 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

Adult check-in
2021-09-24
Report sent to call center — days 1–6 daily, dose 1
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)
2021-09-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-09-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Itching · Headache, 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
2021-09-29
Call 1 — Left Voicemail
2021-10-02
Survey response — day 7, dose 1
MedDRA: Cough, Rhinorrhoea, Upper-airway cough syndrome — Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · 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: Nasal drip, runny nose, cough

MedDRA releases: 2024-11 · check-in free text available
2021-10-02
Report sent to call center — day 7, dose 1
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
Survey response — day 14, dose 1
MedDRA: Hypoaesthesia, Muscle spasms — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Cramps, spasms down my leg and calf especially during the night trying to sleep. Numbness in the legs during the day.

MedDRA releases: 2024-11 · check-in free text available
2021-10-07
Call successful
Participant prefers to complete VAERS report online
2021-10-14
Survey response — day 21, dose 1
MedDRA: Fatigue, Muscle spasms, Pulpitis dental, Stomatitis — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Cramps down my legs and in my right calffatiguemouth and teeth inflammation

MedDRA releases: 2024-11 · check-in free text available
2021-10-21
Dose 2 — Moderna
2021-10-21
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-10-22
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-10-23
Survey response — days 1–6 daily, dose 2
MedDRA: Muscle spasms, Paraesthesia — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Tingling in feet and spasms and cramps in my calf and right foot.

MedDRA releases: 2024-11 · check-in free text available
2021-10-24
Survey response — days 1–6 daily, dose 2
MedDRA: Hypoaesthesia, Muscle spasms — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · 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, Outpatient clinic or urgent care clinic visit

Free text: Spasms in my right leg and numbness in my hand.

MedDRA releases: 2024-11 · check-in free text available
2021-10-24
Report sent to call center — days 1–6 daily, 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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-25
Survey response — days 1–6 daily, dose 2
MedDRA: Noninfective gingivitis, Stomatitis — Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · 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: Mouth sores and inflamed gums

MedDRA releases: 2024-11 · check-in free text available
2021-10-25
Report sent to call center — days 1–6 daily, 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)
2021-10-26
Survey response — days 1–6 daily, dose 2
MedDRA: Noninfective gingivitis, Stomatitis — Feeling: Fair · Site: Pain, Itching · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · 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: Mouth sores on the inside of my cheeks and gums

MedDRA releases: 2024-11 · check-in free text available
2021-10-26
Report sent to call center — days 1–6 daily, 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)
2021-10-26
Call successful
Participant prefers to complete VAERS report online
2021-10-27
Survey response — days 1–6 daily, dose 2
MedDRA: Noninfective gingivitis — Feeling: Fair · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Gum inflammation

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Call 1 — Left Voicemail
2021-10-30
Survey response — day 7, dose 2
MedDRA: Muscle spasms, Noninfective gingivitis — Feeling: Poor · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Gum inflammation and right leg spasms and cramps

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-11-11
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-11-18
Survey response — day 28, dose 2
MedDRA: Loss of libido, Noninfective gingivitis, Stomatitis, Unevaluable event — Feeling: Fair · 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: Urine strength and flowejaculation and compounded loss of libidomouth and gum sores??

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Report sent to call center — day 28, 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)
2021-11-23
Call 1 — Left Voicemail
2021-11-25
Survey response — day 35, dose 2
MedDRA: Depression, Dysuria, Libido decreased — Feeling: Fair · 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: Besides decrease libido and different sensations in urination but mentally I'm struggling with depression.

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Report sent to call center — day 35, 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)
2021-12-02
Survey response — day 42, dose 2
MedDRA: Decreased appetite, Depression — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Depression and loss of appetite

MedDRA releases: 2024-11 · check-in free text available
2021-12-02
Report sent to call center — day 42, 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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-03
Call 1 — Left Voicemail
2021-12-03
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-01-14
Call 1 — Left Voicemail
2022-01-22
Survey response — 3 months, dose 2
MedDRA: COVID-19, Dyspnoea, Noninfective gingivitis, Pre-existing disease, Respiratory disorder — Feeling: Fair · 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: After having COVID again and upper respiratory issues for a month. My gums are inflamed and my breathing is labored and heavy.

MedDRA releases: 2024-11 · check-in free text available
2022-01-22
Report sent to call center — 3 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 · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-01-24
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-09-23	Moderna	No
2	2021-10-21	Moderna	No

Call center

9 call center cases

5 successful · 4 unsuccessful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 9 — day 0, dose 1

2021-09-23

Systemic reaction (other): Dizziness

Release 9 — day 7, dose 1

2021-10-02

Systemic reaction (other): Nasal drip, runny nose, cough

Release 10 — day 14, dose 1

2021-10-07

Symptoms: Cramps, spasms down my leg and calf especially during the night trying to sleep. Numbness in the legs during the day.

Release 10 — day 21, dose 1

2021-10-14

Symptoms: Cramps down my legs and in my right calffatiguemouth and teeth inflammation

Release 10 — days 1–6 daily, dose 2

2021-10-23

Systemic reaction (other): Tingling in feet and spasms and cramps in my calf and right foot.

2021-10-24

Systemic reaction (other): Spasms in my right leg and numbness in my hand.

2021-10-25

Systemic reaction (other): Mouth sores and inflamed gums

2021-10-26

Systemic reaction (other): Mouth sores on the inside of my cheeks and gums

2021-10-27

Systemic reaction (other): Gum inflammation

Release 10 — day 7, dose 2

2021-10-30

Systemic reaction (other): Gum inflammation and right leg spasms and cramps

Release 10 — day 28, dose 2

2021-11-18

Symptoms: Urine strength and flowejaculation and compounded loss of libidomouth and gum sores??

Release 10 — day 35, dose 2

2021-11-25

Symptoms: Besides decrease libido and different sensations in urination but mentally I'm struggling with depression.

Release 10 — day 42, dose 2

2021-12-02

Symptoms: Depression and loss of appetite

Release 11 — 3 months, dose 2

2022-01-22

Symptoms: After having COVID again and upper respiratory issues for a month. My gums are inflamed and my breathing is labored and heavy.

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	COVID-19	·	·	✓
SD	Decreased appetite	·	·	✓
SD	Depression	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Dysuria	·	·	✓
SD	Fatigue	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Libido decreased	·	·	✓
SD	Loss of libido	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Noninfective gingivitis	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pulpitis dental	·	·	✓
SD	Respiratory disorder	·	·	✓
SD	Stomatitis	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Cough	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Hypoaesthesia	·	·	✓
SRO	Muscle spasms	·	·	✓
SRO	Noninfective gingivitis	·	·	✓
SRO	Paraesthesia	·	·	✓
SRO	Rhinorrhoea	·	·	✓
SRO	Stomatitis	·	·	✓
SRO	Upper-airway cough syndrome	·	·	✓

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