3Q2-28927-74822

3 vaccinations 7 coded responses 27 check-ins 7 free-text entries 6 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 299 / SC
Registered: 2021-01-22

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

2021-01-20
Dose 1 — Moderna
2021-01-22
Registered in v-safe
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-27
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-10
Survey response — day 21, dose 1
MedDRA: Fatigue — Feeling: Fair

Free text: Increasingly tired. Have set Dr appointment.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-18
Dose 2 — Moderna
2021-02-18
Health check-in — day 0, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-02-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, 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: Fair · Fatigue or tiredness

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-25
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-04
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-11
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-25
Survey response — day 35, dose 2
MedDRA: Condition aggravated, Jaw disorder, Memory impairment, Office visit, Pre-existing disease, Tooth disorder, Toothache — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Tooth, jaw problems.Memory issues. Not new, but appear to be worsening. Under medical care to check it out. · Healthcare visit (other): In person at office.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-01
Survey response — day 42, dose 2
MedDRA: Amnesia, Headache, Medical counselling, Office visit, Vision blurred — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Headache. Gradually blurring vision. Memory loss. Under medical care. Very unlikely caused by vaccine. MRI scheduled. · Healthcare visit (other): Dr. Office

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-20
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-06-09
Call successful
Does not wish to fill out VAERS report
2021-06-09
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-08-19
Survey response — 6 months, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Gastric problems. Old issue but need help with it. Waiting on endoscopy.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-19
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-20
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-08-26
Dose 3 — Moderna
Co-administered: Flu
2021-11-25
Survey response — 3 months, dose 3
MedDRA: Office visit, Periorbital swelling, Sunburn — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Bad sunburn on upper left face, swell around eyes. Eye doc concerned about shingles. Prescribed antiviral. So far so good. · Healthcare visit (other): Office visit.

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-01-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-24
Survey response — 6 months, dose 3
MedDRA: Office visit, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Gastric. Colonoscopy planned. · Healthcare visit (other): Appointments in person

MedDRA releases: 2024-11 · check-in free text available
2022-02-24
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-02-28
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-26
Survey response — 12 months, dose 3
MedDRA: Liver 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 · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Liver disease

MedDRA releases: 2024-11 · check-in free text available
2022-08-26
Report sent to call center — 12 months, 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 · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-08-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-20	Moderna
2	2021-02-18	Moderna
3	2021-08-26	Moderna	Flu

Call center

6 call center cases

6 successful

See the call center timeline

Free text

Release 4 — day 21, dose 1

2021-02-10

Symptoms: Increasingly tired. Have set Dr appointment.

Release 6 — day 35, dose 2

2021-03-25

Symptoms: Tooth, jaw problems.Memory issues. Not new, but appear to be worsening. Under medical care to check it out.

Healthcare visit (other): In person at office.

Release 6 — day 42, dose 2

2021-04-01

Symptoms: Headache. Gradually blurring vision. Memory loss. Under medical care. Very unlikely caused by vaccine. MRI scheduled.

Healthcare visit (other): Dr. Office

Release 9 — 6 months, dose 2

2021-08-19

Symptoms: Gastric problems. Old issue but need help with it. Waiting on endoscopy.

Release 10 — 3 months, dose 3

2021-11-25

Symptoms: Bad sunburn on upper left face, swell around eyes. Eye doc concerned about shingles. Prescribed antiviral. So far so good.

Healthcare visit (other): Office visit.

Release 11 — 6 months, dose 3

2022-02-24

Symptoms: Gastric. Colonoscopy planned.

Healthcare visit (other): Appointments in person

Release 12 — 12 months, dose 3

2022-08-26

Symptoms: Liver disease

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	Amnesia	✓	✓	✓
SD	Condition aggravated	✓	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Jaw disorder	·	·	✓
SD	Liver disorder	·	·	✓
SD	Medical counselling	✓	✓	✓
SD	Memory impairment	✓	✓	✓
SD	Office visit	·	·	✓
SD	Periorbital swelling	·	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Sunburn	·	·	✓
SD	Tooth disorder	·	·	✓
SD	Toothache	✓	✓	○
SD	Unevaluable event	·	·	✓
SD	Vision blurred	✓	✓	✓

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