3Z5-15917-87797

4 vaccinations 7 coded responses 19 check-ins 7 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 070 / NJ
Registered: 2021-02-09

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

2021-02-05
Dose 1 — Moderna
2021-02-09
Registered in v-safe
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Arthritis, Pain in extremity — Feeling: Good · Fatigue or tiredness

Free text: Within two hours following the injection, the arthritis in my left shoulder and right and left elbows suddenly disappeared, and has not returned. One night while sleeping, I woke up with sharp pains around the injection side and in my right shoulder. That cleared

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Asthenia, Lethargy — Feeling: Good

Free text: Mild weakness and lethargy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Health check-in — day 7, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-02-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-05
Dose 2 — Moderna
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia — Feeling: Good · Chills, Joint pains

Free text: Shoulder joint pain night after injection, but went away the next morning

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Fatigue or tiredness

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Survey response — day 14, dose 2
MedDRA: Fatigue — Feeling: Good

Free text: Fatigue and tiredness its more of an issue. I assume it is more related to lack of physical activity, getting fat, and staying in the home.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-10
Survey response — day 35, dose 2
MedDRA: Office visit, Visual impairment — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Significant change in vision. Current eyeglasses do not help.Have an appointment with an ophthalmologist to determine if it can be corrected with new glasses. I am a school bus driver and my vision is very important. · Healthcare visit (other): Ophthalmologist appointment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-04
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Muscular weakness, Pain, Poor quality sleep, Respiratory tract congestion, Somnolence — Feeling: Poor · Be unable to do your normal daily activities

Free text: Got Singtix vaccine yesterday. Lousy night sleep, aching body and joints, weak muscle tone in legs today,, And heavy chest congestion. Fell asleep in middle of day in the recliner, went out in the car and fell asleep for an hourIn the car, got home,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-31
Dose 3 — Moderna
2022-02-17
Call successful
Participant prefers to complete VAERS report online
2022-04-09
Dose 4 — Moderna
2022-04-30
Survey response — day 21, dose 4
MedDRA: Cough, Influenza like illness, Pre-existing disease, Respiratory tract congestion, Rhinorrhoea — Feeling: Good

Free text: Flu like runny nose, coughing, and chest congestion. Some people in my area have the similar condition. Uncertain whether or not it is related to the annual pollen event that occurs at this time of year.

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-05	Moderna
3	2021-10-31	Moderna	No
4	2022-04-09	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-09

Systemic reaction (other): Within two hours following the injection, the arthritis in my left shoulder and right and left elbows suddenly disappeared, and has not returned. One night while sleeping, I woke up with sharp pains around the injection side and in my right shoulder. That cleared

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Mild weakness and lethargy

Release 5 — days 1–6 daily, dose 2

2021-03-07

Systemic reaction (other): Shoulder joint pain night after injection, but went away the next morning

Release 5 — day 14, dose 2

2021-03-19

Symptoms: Fatigue and tiredness its more of an issue. I assume it is more related to lack of physical activity, getting fat, and staying in the home.

Release 7 — day 35, dose 2

2021-04-10

Symptoms: Significant change in vision. Current eyeglasses do not help.Have an appointment with an ophthalmologist to determine if it can be corrected with new glasses. I am a school bus driver and my vision is very important.

Healthcare visit (other): Ophthalmologist appointment

Release 8 — 3 months, dose 2

2021-06-04

Symptoms: Got Singtix vaccine yesterday. Lousy night sleep, aching body and joints, weak muscle tone in legs today,, And heavy chest congestion. Fell asleep in middle of day in the recliner, went out in the car and fell asleep for an hourIn the car, got home, cut off by CDC

Release 11 — day 21, dose 4

2022-04-30

Symptoms: Flu like runny nose, coughing, and chest congestion. Some people in my area have the similar condition. Uncertain whether or not it is related to the annual pollen event that occurs at this time of year.

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	Arthralgia	✓	✓	✓
SD	Cough	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Influenza like illness	·	·	✓
SD	Muscular weakness	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Poor quality sleep	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	Somnolence	✓	✓	✓
SD	Visual impairment	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Arthritis	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Lethargy	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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