497-25976-32897

5 vaccinations 18 coded responses 40 check-ins 17 free-text entries 10 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 208 / MD
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

2021-01-19
Dose 1 — Moderna
2021-01-22
Registered in v-safe
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

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

Adult check-in
2021-01-26
Health check-in — day 7, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-09
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-16
Dose 2 — Moderna
2021-02-16
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Chills, Headache

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Headache, Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Not sure if what I checked off is related to the shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Survey response — days 1–6 daily, dose 2
MedDRA: Cardiac disorder, Hospitalisation — Feeling: Fair · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: DO NOT THINK(BECAUSE OF THE TIME OF THE SHOT) IT IS RELATED. HAVE BEEN IN HOSPITAL SINCE ABOUT 12:15 am FRIDAY.MORRNING. IS PROBABLY CARDIAC RELATED.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: Hospitalisation — Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Could be cardiac related. This is 3rd day I am in hospital since the last shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Survey response — day 7, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Fever · Headache, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: PROBABLY CARDIAC RELSYED

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Report sent to call center — day 7, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-02
Survey response — day 14, dose 2
MedDRA: Cardiac disorder — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Cardiac probkems

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-09
Survey response — day 21, dose 2
MedDRA: Cardiac disorder, Infection — 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, Hospitalization

Free text: Cardiac problems and I have an infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-16
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-23
Survey response — day 35, dose 2
MedDRA: Cardiac disorder — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Strictly cardiac symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-30
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-18
Survey response — 3 months, dose 2
MedDRA: Cardiac disorder, Hospitalisation, Surgery — Feeling: Good · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: HAS NOTHING TO DO WITH COVID. CARDIAC RELATED · Healthcare visit (other): SURGERY

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Report sent to call center — 3 months, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-17
Survey response — 6 months, dose 2
MedDRA: Chills, Constipation, Diarrhoea, Dyspnoea, Fatigue, Headache, Hyperhidrosis, Rhinorrhoea — Feeling: Fair · 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: Difficult breathing ,runny nose, headache,serious fatigue, chills then sweating and just tk make the day complete diarrhea then constipation repeat till it stops.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-17
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-19
Call 1 — Left Voicemail
2021-08-20
Call 2 — Left Voicemail
2021-08-23
Call 3 — Left Voicemail
2021-09-09
Dose 3 — Moderna
2021-10-26
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-10
Survey response — 6 months, dose 3
MedDRA: Cardiac disorder — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Cardiac issue's.

MedDRA releases: 2024-11 · check-in free text available
2022-03-10
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-03-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-14
Dose 4 — Moderna
2022-04-15
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness · Fever · Chills · Be unable to do your normal daily activities

Adult check-in
2022-04-16
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness

Adult check-in
2022-04-17
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2022-04-18
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Itching · Chills, Headache

Adult check-in
2022-04-19
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Itching · Chills, Fatigue or tiredness

Adult check-in
2022-04-20
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Itching · Headache, Fatigue or tiredness

Adult check-in
2022-04-21
Health check-in — day 7, dose 4
Feeling: Fair · Headache

Adult check-in
2022-04-28
Survey response — day 14, dose 4
MedDRA: Chills, Cough — Feeling: Poor · Be unable to do your normal daily activities

Free text: SINCE MY LAST SHOT CHILLS,COUGHING ETC

MedDRA releases: 2024-11 · check-in free text available
2022-05-05
Survey response — day 21, dose 4
MedDRA: COVID-19, SARS-CoV-2 test positive — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Contracted vovid tested positive on 4/30 BY PCR TEST @(b)(6) HOSPITAL (b)(6)

MedDRA releases: 2024-11 · check-in free text available
2022-05-05
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

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
2022-05-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-12
Survey response — day 28, dose 4
MedDRA: Dyspnoea, Fatigue, Gait disturbance, Headache — Feeling: Poor · Be unable to do your normal daily activities

Free text: DIFFICULTY WALKING , TAKING DEPP BREATHS,HEADACHES AND FATIGUE.

MedDRA releases: 2024-11 · check-in free text available
2022-05-19
Survey response — day 35, dose 4
MedDRA: Chest pain, Dyspnoea, Fatigue, Flank pain — 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: Difficulty breathing, fatigue,chest and side pain.

MedDRA releases: 2024-11 · check-in free text available
2022-05-19
Report sent to call center — day 35, 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)
2022-05-20
Call 2 — Left Voicemail
2022-05-26
Survey response — day 42, dose 4
MedDRA: Abdominal discomfort, Fatigue, Flank pain, Headache, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities

Free text: BREATHING,FATIGUE, INCREASE HEADACHES, STOMACH&SIDE DISTRESS

MedDRA releases: 2024-11 · check-in free text available
2022-07-14
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-10-06
Dose 5 — Moderna
2022-10-13
Survey response — 6 months, dose 4
MedDRA: Fatigue, Headache, Myalgia — Feeling: Good · Be unable to do your normal daily activities

Free text: Fatigue, headache, Muscle ache.

MedDRA releases: 2024-11 · check-in free text available
2023-04-12
Survey response — 6 months, dose 5
MedDRA: Loss of personal independence in daily activities, Muscular weakness, Myalgia, Pain — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11
2023-04-12
Report sent to call center — 6 months, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2023-04-13
Call 1 — Left Voicemail
2023-04-13
Call 1 — Left Voicemail
2023-04-14
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-19	Moderna
2	2021-02-16	Moderna
3	2021-09-09	Moderna	No
4	2022-04-14	Moderna	No
5	2022-10-06	Moderna	No

Call center

10 call center cases

9 successful · 1 unsuccessful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-19

Systemic reaction (other): No

2021-02-20

Systemic reaction (other): Not sure if what I checked off is related to the shot.

2021-02-21

Systemic reaction (other): DO NOT THINK(BECAUSE OF THE TIME OF THE SHOT) IT IS RELATED. HAVE BEEN IN HOSPITAL SINCE ABOUT 12:15 am FRIDAY.MORRNING. IS PROBABLY CARDIAC RELATED.

2021-02-22

Systemic reaction (other): Could be cardiac related. This is 3rd day I am in hospital since the last shot.

Release 4 — day 7, dose 2

2021-02-23

Healthcare visit (other): PROBABLY CARDIAC RELSYED

Release 4 — day 14, dose 2

2021-03-02

Symptoms: Cardiac probkems

Release 5 — day 21, dose 2

2021-03-09

Symptoms: Cardiac problems and I have an infection

Release 6 — day 35, dose 2

2021-03-23

Symptoms: Strictly cardiac symptoms

Release 8 — 3 months, dose 2

2021-05-18

Symptoms: HAS NOTHING TO DO WITH COVID. CARDIAC RELATED

Healthcare visit (other): SURGERY

Release 9 — 6 months, dose 2

2021-08-17

Symptoms: Difficult breathing ,runny nose, headache,serious fatigue, chills then sweating and just tk make the day complete diarrhea then constipation repeat till it stops.

Release 11 — 6 months, dose 3

2022-03-10

Symptoms: Cardiac issue's.

Release 11 — day 14, dose 4

2022-04-28

Symptoms: SINCE MY LAST SHOT CHILLS,COUGHING ETC

Release 11 — day 21, dose 4

2022-05-05

Symptoms: Contracted vovid tested positive on 4/30 BY PCR TEST @(b)(6) HOSPITAL (b)(6)

redacted (b)(6)

Release 11 — day 28, dose 4

2022-05-12

Symptoms: DIFFICULTY WALKING , TAKING DEPP BREATHS,HEADACHES AND FATIGUE.

Release 11 — day 35, dose 4

2022-05-19

Symptoms: Difficulty breathing, fatigue,chest and side pain.

Release 11 — day 42, dose 4

2022-05-26

Symptoms: BREATHING,FATIGUE, INCREASE HEADACHES, STOMACH&SIDE DISTRESS

Release 12 — 6 months, dose 4

2022-10-13

Symptoms: Fatigue, headache, Muscle ache.

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	Hospitalisation	✓	✓	✓
HCVO	Pain	·	·	✓
HCVO	Surgery	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Abdominal discomfort	·	·	✓
SD	Cardiac disorder	✓	✓	✓
SD	Chest pain	·	·	✓
SD	Chills	✓	·	✓
SD	Constipation	✓	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	✓	·	✓
SD	Dyspnoea	✓	·	✓
SD	Fatigue	✓	·	✓
SD	Flank pain	·	·	✓
SD	Gait disturbance	·	·	✓
SD	Headache	✓	·	✓
SD	Hyperhidrosis	✓	·	✓
SD	Infection	✓	✓	✓
SD	Loss of personal independence in daily activities	·	·	✓
SD	Muscular weakness	·	·	✓
SD	Myalgia	·	·	✓
SD	Rhinorrhoea	✓	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Cardiac disorder	✓	✓	✓
SRO	Hospitalisation	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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