3JL-24284-27881

5 vaccinations 17 coded responses 45 check-ins 16 free-text entries 3 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 280 / NC
Registered: 2021-02-09

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-02-09
Registered in v-safe
2021-02-09
Dose 1 — Moderna
2021-02-09
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain, Myalgia — Feeling: Good · Site: Pain

Free text: Just soreness when touched in muscle immediately below injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · Abdominal pain, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-16
Health check-in — day 7, dose 1
Feeling: Good · Site: Swelling, Itching · Abdominal pain, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-23
Survey response — day 14, dose 1
MedDRA: Cough, Respiratory tract congestion, Secretion discharge — Feeling: Good

Free text: Congestion with thick hard to cough up or dislodge mucus in throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-03-09
Dose 2 — Moderna
2021-03-09
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Productive cough, Respiratory tract congestion — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: Congestion coughing up whiteish film

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — day 7, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-30
Survey response — day 21, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Tiredness, fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — day 28, dose 2
MedDRA: Balance disorder, Dizziness, Hypoaesthesia, Muscular weakness, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Pain in legs weakness, numbness in fingers and toes dizziness lose of balance

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — day 35, dose 2
MedDRA: Arthralgia, Asthenia, Fatigue, Pain in extremity, Swelling — Feeling: Fair · Be unable to do your normal daily activities

Free text: Pain in right leg and hip, swelling tiredness and weakness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-08
Survey response — 3 months, dose 2
MedDRA: Gait disturbance, Muscle spasms, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Pain or cramps in thighs making it difficult to walk especially in the mornings

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-09
Survey response — 6 months, dose 2
MedDRA: Gait disturbance, Pain in extremity — Feeling: Fair

Free text: Pain in back of thighs sometimes causing stumbling

MedDRA releases: 2024-11 · check-in free text available
2021-10-21
Dose 3 — Moderna
2021-10-28
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-04
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-11
Survey response — day 21, dose 3
MedDRA: Respiratory tract congestion — Feeling: Fair

Free text: Some congestion like catching a cold

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Survey response — day 28, dose 3
MedDRA: Increased viscosity of upper respiratory secretion, Respiratory tract congestion — Feeling: Fair

Free text: Lingering congestion with thick mucus

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-02
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-20
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-21
Dose 4 — Moderna
2022-05-18
Survey response — day 21, dose 4
MedDRA: Influenza like illness — Feeling: Poor · Be unable to do your normal daily activities

Free text: fells like the flu or something

MedDRA releases: 2024-11 · check-in free text available
2022-05-19
Survey response — day 28, dose 4
MedDRA: Headache, Influenza like illness, Myalgia, Paraesthesia — Feeling: Fair · Be unable to do your normal daily activities

Free text: body muscles aches and pain headaches, tingling of fingers hands and legs flu like symptoms no high fever

MedDRA releases: 2024-11 · check-in free text available
2022-05-26
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-06-02
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-07-21
Survey response — 3 months, dose 4
MedDRA: Myalgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: muscle pain in arms and thighs

MedDRA releases: 2024-11 · check-in free text available
2022-10-06
Dose 5 — Moderna
2022-10-18
Health check-in — day 7, dose 5
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-20
Health check-in — day 14, dose 5
Feeling: Fair

Adult check-in
2022-10-27
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-03
Survey response — day 28, dose 5
MedDRA: Pain in extremity — Feeling: Fair

Free text: Pain in arms and legs

MedDRA releases: 2024-11 · check-in free text available
2022-11-10
Survey response — day 35, dose 5
MedDRA: Abdominal pain upper, Office visit, Pain in extremity — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Increased pain in arms and legs and stomach pains · Healthcare visit (other): Doctors visit

MedDRA releases: 2024-11 · check-in free text available
2022-11-10
Report sent to call center — day 35, dose 5
Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-11
Call 1 — Left Voicemail
2022-11-14
Call successful
Participant prefers to complete VAERS report online
2022-11-17
Survey response — day 42, dose 5
MedDRA: Bursitis, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: right elbow olecranon bursitis · Healthcare visit (other): primary care doctor

MedDRA releases: 2024-11 · check-in free text available
2022-11-17
Report sent to call center — day 42, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-18
Call successful
Participant prefers to complete VAERS report online
2023-01-05
Health check-in — 3 months, dose 5
Feeling: Fair

Adult check-in
2023-04-07
Survey response — 6 months, dose 5
MedDRA: Office visit, Paraesthesia — Feeling: Fair · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-04-07
Report sent to call center — 6 months, dose 5
Get care from a doctor or other healthcare professional

1 call case(s)
2023-04-12
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Moderna
2	2021-03-09	Moderna
3	2021-10-21	Moderna	No
4	2022-04-21	Moderna	No
5	2022-10-06	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Just soreness when touched in muscle immediately below injection site

Release 4 — day 14, dose 1

2021-02-23

Symptoms: Congestion with thick hard to cough up or dislodge mucus in throat

Release 5 — days 1–6 daily, dose 2

2021-03-15

Systemic reaction (other): Congestion coughing up whiteish film

Release 6 — day 21, dose 2

2021-03-30

Symptoms: Tiredness, fatigue

Release 7 — day 28, dose 2

2021-04-06

Symptoms: Pain in legs weakness, numbness in fingers and toes dizziness lose of balance

Release 7 — day 35, dose 2

2021-04-13

Symptoms: Pain in right leg and hip, swelling tiredness and weakness

Release 8 — 3 months, dose 2

2021-06-08

Symptoms: Pain or cramps in thighs making it difficult to walk especially in the mornings

Release 9 — 6 months, dose 2

2021-09-09

Symptoms: Pain in back of thighs sometimes causing stumbling

Release 10 — day 21, dose 3

2021-11-11

Symptoms: Some congestion like catching a cold

Release 10 — day 28, dose 3

2021-11-18

Symptoms: Lingering congestion with thick mucus

Release 11 — day 21, dose 4

2022-05-18

Symptoms: fells like the flu or something

Release 11 — day 28, dose 4

2022-05-19

Symptoms: body muscles aches and pain headaches, tingling of fingers hands and legs flu like symptoms no high fever

Release 12 — 3 months, dose 4

2022-07-21

Symptoms: muscle pain in arms and thighs

Release 12 — day 28, dose 5

2022-11-03

Symptoms: Pain in arms and legs

Release 12 — day 35, dose 5

2022-11-10

Symptoms: Increased pain in arms and legs and stomach pains

Healthcare visit (other): Doctors visit

Release 12 — day 42, dose 5

2022-11-17

Symptoms: right elbow olecranon bursitis

Healthcare visit (other): primary care doctor

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	Office visit	·	·	✓
SD	Abdominal pain upper	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Balance disorder	✓	✓	✓
SD	Bursitis	·	·	✓
SD	Cough	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gait disturbance	✓	✓	✓
SD	Headache	·	·	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Increased viscosity of upper respiratory secretion	·	·	✓
SD	Influenza like illness	·	·	✓
SD	Muscle spasms	✓	✓	✓
SD	Muscular weakness	✓	✓	✓
SD	Myalgia	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Paraesthesia	·	·	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Secretion discharge	✓	✓	✓
SD	Swelling	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Productive cough	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓

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