3ZU-16485-08070

1 vaccination 10 coded responses 14 check-ins 10 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 945 / CA
Registered: 2021-03-16

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

2021-03-14
Dose 1 — Moderna
2021-03-16
Registered in v-safe
2021-03-16
Survey response — days 1–6 daily, dose 1
MedDRA: Mouth swelling, Swelling face — Feeling: Poor · Site: Pain · Fever · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Swelling in face and mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — days 1–6 daily, dose 1
MedDRA: Pharyngeal swelling, Swelling face — Feeling: Poor · Site: Pain, Itching · Fever · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Face and throat swelling

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Swelling face — Feeling: Poor · Site: Pain · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Swelling of face

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Survey response — days 1–6 daily, dose 1
MedDRA: Swelling face — Feeling: Poor · Site: Redness, Swelling, Itching · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Swelling of face

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — days 1–6 daily, dose 1
MedDRA: Swelling face — Feeling: Poor · Site: Swelling, Itching · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Swelling of face

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Survey response — day 7, dose 1
MedDRA: Swelling face — Feeling: Fair · Site: Swelling, Itching · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Swelling in the face

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — day 14, dose 1
MedDRA: Dyspnoea, Rash, Swelling face — Feeling: Poor · Be unable to do your normal daily activities

Free text: Rash on my back swelling of my face breathing difficulty. This is very very toxic

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Survey response — day 21, dose 1
MedDRA: Dyspnoea, Peripheral swelling, Rash, Swelling face — Feeling: Poor · Be unable to do your normal daily activities

Free text: Face and hand swelling, rash on my back, and some breathing difficulty. Symptoms are not going away.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-04-19
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-04-25
Survey response — day 42, dose 1
MedDRA: Dyspnoea, Nasal congestion, Rash, Swelling face — Feeling: Fair · Be unable to do your normal daily activities

Free text: Swelling of the face, rash iny back, some breathing difficulty. Much worse for one day like a relapse, then simmered down. This stuff is very poisonous

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-16
Health check-in — 3 months, dose 1
Feeling: Fair

Adult check-in
2021-09-14
Health check-in — 6 months, dose 1
Feeling: Fair

Adult check-in
2021-12-17
Call successful
Participant prefers to complete VAERS report online
2022-03-14
Survey response — 12 months, dose 1
MedDRA: Arthralgia, Asthenia, Dyspnoea, Feeling abnormal, Tremor — Feeling: Fair · Be unable to do your normal daily activities

Free text: Severe joint pain, wrists and hands, and sometimes shoulders, shortness of breath, shaking hands and arms, severe lack of energy, not feeling real good and very low on energy. Its been 14 months with one Moderna shot.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-14	Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-16

Systemic reaction (other): Swelling in face and mouth

2021-03-17

Systemic reaction (other): Face and throat swelling

2021-03-18

Systemic reaction (other): Swelling of face

2021-03-19

Systemic reaction (other): Swelling of face

Release 6 — days 1–6 daily, dose 1

2021-03-20

Systemic reaction (other): Swelling of face

Release 6 — day 7, dose 1

2021-03-21

Systemic reaction (other): Swelling in the face

Release 6 — day 14, dose 1

2021-04-01

Symptoms: Rash on my back swelling of my face breathing difficulty. This is very very toxic

Release 6 — day 21, dose 1

2021-04-04

Symptoms: Face and hand swelling, rash on my back, and some breathing difficulty. Symptoms are not going away.

Release 7 — day 42, dose 1

2021-04-25

Symptoms: Swelling of the face, rash iny back, some breathing difficulty. Much worse for one day like a relapse, then simmered down. This stuff is very poisonous

Release 11 — 12 months, dose 1

2022-03-14

Symptoms: Severe joint pain, wrists and hands, and sometimes shoulders, shortness of breath, shaking hands and arms, severe lack of energy, not feeling real good and very low on energy. Its been 14 months with one Moderna shot.

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	Arthralgia	·	·	✓
SD	Asthenia	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Feeling abnormal	·	·	✓
SD	Nasal congestion	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Swelling face	✓	✓	✓
SD	Tremor	·	·	✓
SRO	Mouth swelling	✓	✓	✓
SRO	Pharyngeal swelling	✓	✓	✓
SRO	Swelling face	✓	✓	✓

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