487-11189-78022

4 vaccinations 13 coded responses 41 check-ins 13 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 199 / DE
Registered: 2021-01-23

Relationship: Self
Race: N/A
Ethnicity: N/A

Possible VAERS report

VAERS ID	Confidence	Score	Runner-up	Shared symptoms	Dose	State	VAERS vaccinated / onset / received	Call case
2314136 (opens in a new window)	high	10 / 11	2	2 of 7 VAERS symptoms	same dose (2)	IN differs	2021-02-23 / 2021-03-01 / 2022-06-09 received the same day as the last call	case 962350

From the VAERS matching of call center cases (loader/vaers_match_*). Only the best match is shown, and only if it scores 8 or more out of 11. The score adds up timing (VAERS received soon after the call center contact), dose and shared symptoms; state only breaks ties. Confidence is high when the score is 8+ and at least 3 points ahead of the runner-up, medium when 5+ and 2 ahead, otherwise low. A match is a likely link, not a confirmed one.

Timeline

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

2021-01-23
Registered in v-safe
2021-01-23
Dose 1 — Moderna
2021-01-23
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Fair · Fever · Joint pains, Fatigue or tiredness, Abdominal pain

Free text: Itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Good

Free text: Itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Fair · Fatigue or tiredness

Free text: Itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-13
Survey response — day 21, dose 1
MedDRA: Feeling abnormal — Feeling: Fair

Free text: Just didnt feel good

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-23
Dose 2 — Moderna
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Abdominal pain

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-02
Survey response — day 7, dose 2
MedDRA: Musculoskeletal chest pain — Feeling: Fair

Free text: Right lower rib cage pain when I breathe

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-06
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-24
Survey response — 6 months, dose 2
MedDRA: Colonoscopy abnormal, Streptococcal urinary tract infection — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Strep b UTI was the resul of colonoscopy

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-24
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-30
Call 1 — Left Voicemail
2021-09-21
Dose 3 — Moderna
2021-10-27
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-02
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-21
Survey response — 3 months, dose 3
MedDRA: Immune system disorder — Feeling: Good

Free text: My immune system is showing sign of weakness

MedDRA releases: 2024-11 · check-in free text available
2022-05-18
Dose 4 — Moderna
2022-05-18
Health check-in — day 0, dose 4
Feeling: Fair · None

Adult check-in
2022-05-20
Survey response — days 1–6 daily, dose 4
MedDRA: Blood glucose fluctuation, Dizziness — Feeling: Poor · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizziness and irractic glucose levels

MedDRA releases: 2024-11 · check-in free text available
2022-05-21
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Joint pains

Adult check-in
2022-05-22
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · None

Adult check-in
2022-05-23
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Muscle or body aches

Adult check-in
2022-05-24
Survey response — days 1–6 daily, dose 4
MedDRA: Dyspnoea — Feeling: Fair · Fatigue or tiredness

Free text: Shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2022-05-26
Health check-in — day 7, dose 4
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-06-01
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-06-08
Survey response — day 21, dose 4
MedDRA: Dyspnoea, Heart rate increased — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Shortness of breath & accelerated heart rate with slight exertion or exercise

MedDRA releases: 2024-11 · check-in free text available
2022-06-08
Report sent to call center — day 21, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-06-09
Call successful
Completed over the phone
2022-06-09
Call successful
Not applicable - Accidental Reporting
2022-06-15
Survey response — day 28, dose 4
MedDRA: Dyspnoea, Heart rate increased, Office visit — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Shortness of breath and elevated heart rate. · Healthcare visit (other): Cardiac visit & pulmonary function tests scheduled

MedDRA releases: 2024-11 · check-in free text available
2022-06-15
Report sent to call center — day 28, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-06-16
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-22
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-06-29
Survey response — day 42, dose 4
MedDRA: Oxygen saturation decreased — Feeling: Fair · Be unable to do your normal daily activities

Free text: Low oxygen with exertion

MedDRA releases: 2024-11 · check-in free text available
2022-08-17
Health check-in — 3 months, dose 4
Feeling: Poor

Adult check-in
2022-11-18
Survey response — 6 months, dose 4
MedDRA: Pulmonary hypertension — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Pulmonary hypertension

MedDRA releases: 2024-11 · check-in free text available
2022-11-18
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-21
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-05-22
Health check-in — 12 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-23	Moderna
2	2021-02-23	Moderna
3	2021-09-21	Moderna	No
4	2022-05-18	Moderna	No

Call center

4 call center cases

4 successful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-27

Systemic reaction (other): Itching

Release 3 — days 1–6 daily, dose 1

2021-01-28

Systemic reaction (other): Itching

2021-01-29

Systemic reaction (other): Itching

Release 4 — day 21, dose 1

2021-02-13

Symptoms: Just didnt feel good

Release 4 — day 7, dose 2

2021-03-02

Systemic reaction (other): Right lower rib cage pain when I breathe

Release 9 — 6 months, dose 2

2021-08-24

Symptoms: Strep b UTI was the resul of colonoscopy

Release 10 — 3 months, dose 3

2021-12-21

Symptoms: My immune system is showing sign of weakness

Release 11 — days 1–6 daily, dose 4

2022-05-20

Systemic reaction (other): Dizziness and irractic glucose levels

2022-05-24

Systemic reaction (other): Shortness of breath

Release 11 — day 21, dose 4

2022-06-08

Symptoms: Shortness of breath & accelerated heart rate with slight exertion or exercise

Release 12 — day 28, dose 4

2022-06-15

Symptoms: Shortness of breath and elevated heart rate.

Healthcare visit (other): Cardiac visit & pulmonary function tests scheduled

Release 12 — day 42, dose 4

2022-06-29

Symptoms: Low oxygen with exertion

Release 12 — 6 months, dose 4

2022-11-18

Symptoms: Pulmonary hypertension

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	Colonoscopy abnormal	✓	·	✓
SD	Dyspnoea	·	·	✓
SD	Feeling abnormal	✓	✓	✓
SD	Heart rate increased	·	·	✓
SD	Immune system disorder	·	·	✓
SD	Oxygen saturation decreased	·	·	✓
SD	Pulmonary hypertension	·	·	✓
SD	Streptococcal urinary tract infection	✓	·	✓
SRO	Blood glucose fluctuation	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Musculoskeletal chest pain	✓	✓	✓
SRO	Pruritus	✓	✓	✓

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