496-27953-88721

4 vaccinations 15 coded responses 26 check-ins 15 free-text entries 2 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 752 / TX
Registered: 2021-03-15

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

2021-03-15
Registered in v-safe
2021-03-15
Dose 1 — Moderna
2021-03-15
Survey response — day 0, dose 1
MedDRA: Pruritus — Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Free text: itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Survey response — days 1–6 daily, dose 1
MedDRA: Micturition disorder, Pruritus — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Burning urination. Little itchy after urination. Still having body itches for no apparent reason.

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: Defaecation urgency, Dysuria, Micturition urgency, Pain, Sleep disorder — Feeling: Poor · Site: Pain, Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work

Free text: burning urination and immediacy to get to the bathroom for 1 & 2, want to sleep, but cant stay asleep for longer than 45 minutes due to aches

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: Arthralgia, Insomnia, Myalgia — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Free text: joint pain and muscle aches kept me awake last night. feel better today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — days 1–6 daily, dose 1
MedDRA: Herpes zoster — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work

Free text: shingles rash

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: Pruritus, Rash, Skin weeping — Feeling: Good · Headache, Joint pains, Muscle or body aches · Be unable to work

Free text: mild itching for no apparent reason. phantom itching in palm and heel of hand. some seeping of rash on thigh, but minor.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus, Rash — Feeling: Good · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: less intense itching. less weeping of rash.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — day 7, dose 1
MedDRA: Herpes zoster, Pruritus — Feeling: Good · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: shingles rash, itching but no weeping

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-12
Survey response — day 28, dose 1
MedDRA: Myalgia — Feeling: Fair · Be unable to work

Free text: muscle aches all over

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Dose 2 — Moderna
2021-04-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Muscle or body aches, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site

Adult check-in
2021-04-20
Health check-in — day 7, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-04-27
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-04
Survey response — day 21, dose 2
MedDRA: Eyelid rash — Feeling: Good

Free text: rash on both of my eyelids.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Survey response — day 28, dose 2
MedDRA: Eyelid rash — Feeling: Good

Free text: Rash on eye lids had gotten progressively worse. Thought it would go away like it usually does, but hasnt. Started treating it with various medications and lotions. Rash has seemed to dry up which is different from before. Still some residue on bo

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-25
Survey response — day 42, dose 2
MedDRA: Eyelid rash, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Rash on eyes is getting worse. · Healthcare visit (other): Scheduled Drs. appt. Havent seen Dr. yet.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-25
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-14
Survey response — 3 months, dose 2
MedDRA: Eyelid rash, Fatigue, Feeling abnormal, Gingival pain, Hypersomnia, Oropharyngeal pain, Pain, Pruritus, Sedation — 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 · Telehealth, virtual health, or email health consultation

Free text: Rash on my eyelids is still present, but improved. Developed soreness in gums that lasted for 3 weeks. Have chronic feeling of sedation and fatigue. Sleeping a lot. Sometimes feel deep tissue soreness that Ive never had before. Phantom itching.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-14
Report sent to call center — 3 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-22
Call successful
Does not wish to fill out VAERS report
2021-10-12
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-11
Dose 3 — Moderna
2022-04-08
Dose 4 — Moderna
2022-04-13
Survey response — 12 months, dose 2
MedDRA: Influenza, Parosmia, Suspected COVID-19, Taste disorder — Feeling: Fair · Be unable to work or attend school

Free text: 2nd week of January, had flu symptoms, but after symptoms subsided, had taste/smell issues. Suspect had Omitron, but was unverified.

MedDRA releases: 2024-11 · check-in free text available
2022-04-14
Survey response — days 1–6 daily, dose 4
MedDRA: Brain fog — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Brain fog

MedDRA releases: 2024-11 · check-in free text available
2022-04-15
Health check-in — day 7, dose 4
Feeling: Good · Muscle or body aches

Adult check-in
2022-04-23
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-01
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-07
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-15	Moderna
2	2021-04-13	Moderna
3	2021-11-11	Moderna	No
4	2022-04-08	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 5 — day 0, dose 1

2021-03-15

Systemic reaction (other): itching

Release 5 — days 1–6 daily, dose 1

2021-03-16

Systemic reaction (other): Burning urination. Little itchy after urination. Still having body itches for no apparent reason.

2021-03-17

Systemic reaction (other): burning urination and immediacy to get to the bathroom for 1 & 2, want to sleep, but cant stay asleep for longer than 45 minutes due to aches

2021-03-18

Systemic reaction (other): joint pain and muscle aches kept me awake last night. feel better today.

2021-03-19

Systemic reaction (other): shingles rash

Release 6 — days 1–6 daily, dose 1

2021-03-20

Systemic reaction (other): mild itching for no apparent reason. phantom itching in palm and heel of hand. some seeping of rash on thigh, but minor.

2021-03-21

Systemic reaction (other): less intense itching. less weeping of rash.

Release 6 — day 7, dose 1

2021-03-22

Systemic reaction (other): shingles rash, itching but no weeping

Release 7 — day 28, dose 1

2021-04-12

Symptoms: muscle aches all over

Release 8 — day 21, dose 2

2021-05-04

Symptoms: rash on both of my eyelids.

Release 8 — day 28, dose 2

2021-05-11

Symptoms: Rash on eye lids had gotten progressively worse. Thought it would go away like it usually does, but hasnt. Started treating it with various medications and lotions. Rash has seemed to dry up which is different from before. Still some residue on bo

Release 8 — day 42, dose 2

2021-05-25

Symptoms: Rash on eyes is getting worse.

Healthcare visit (other): Scheduled Drs. appt. Havent seen Dr. yet.

Release 9 — 3 months, dose 2

2021-07-14

Symptoms: Rash on my eyelids is still present, but improved. Developed soreness in gums that lasted for 3 weeks. Have chronic feeling of sedation and fatigue. Sleeping a lot. Sometimes feel deep tissue soreness that Ive never had before. Phantom itching.

Release 11 — 12 months, dose 2

2022-04-13

Symptoms: 2nd week of January, had flu symptoms, but after symptoms subsided, had taste/smell issues. Suspect had Omitron, but was unverified.

Release 11 — days 1–6 daily, dose 4

2022-04-14

Systemic reaction (other): Brain fog

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	Unevaluable event	✓	✓	✓
SD	Eyelid rash	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	·	✓
SD	Gingival pain	✓	✓	✓
SD	Hypersomnia	✓	·	✓
SD	Influenza	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Oropharyngeal pain	○	✓	○
SD	Pain	✓	·	✓
SD	Parosmia	·	·	✓
SD	Pruritus	✓	✓	✓
SD	Rash	○	○	○
SD	Sedation	○	✓	○
SD	Suspected COVID-19	·	·	✓
SD	Taste disorder	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Brain fog	·	·	✓
SRO	Defaecation urgency	✓	✓	✓
SRO	Dysuria	✓	✓	✓
SRO	Herpes zoster	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Micturition disorder	✓	✓	✓
SRO	Micturition urgency	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Skin weeping	✓	✓	✓
SRO	Sleep disorder	✓	✓	✓

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