49H-30997-49527

4 vaccinations 12 coded responses 22 check-ins 11 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 150 / PA
Registered: 2021-10-13

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

2021-02-10
Dose 1 — Moderna
2021-03-10
Dose 2 — Moderna
2021-10-13
Registered in v-safe
2021-10-13
Dose 3 — Moderna
2021-10-13
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · None

Adult check-in
2021-10-14
Survey response — days 1–6 daily, dose 3
MedDRA: Tenderness — Feeling: Poor · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: My elbows are tender

MedDRA releases: 2024-11 · check-in free text available
2021-10-15
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Abdominal pain

Adult check-in
2021-10-17
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-10-18
Survey response — days 1–6 daily, dose 3
MedDRA: Arthralgia — Feeling: Fair · Site: Pain, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: Left knee sharp pain under my knee cap. Same kind of pain I had in my hips after March 10 second dose of Maderna

MedDRA releases: 2024-11 · check-in free text available
2021-10-19
Survey response — days 1–6 daily, dose 3
MedDRA: Arthralgia — Feeling: Fair · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: Left knee sharp pain. I have never had knee pain

MedDRA releases: 2024-11 · check-in free text available
2021-10-20
Health check-in — day 7, dose 3
Feeling: Fair · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-10-27
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-05
Survey response — day 21, dose 3
MedDRA: Abdominal pain, Arthralgia, Pain in extremity, Vaccine positive rechallenge — Feeling: Fair · Be unable to do your normal daily activities

Free text: Like when I got my second shot the booster now has my right hip hurting 1 to 10 a 7. I have abdominal pain and my legs ache my elbows hurt. I am 67 and retired

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-11-19
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-11-26
Survey response — day 42, dose 3
MedDRA: Abdominal pain, Fatigue, Oropharyngeal pain, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sore throat. Taste. Fatigue abdominal pain

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-21
Call successful
Participant prefers to complete VAERS report online
2022-01-12
Survey response — 3 months, dose 3
MedDRA: Abdominal pain, Arthralgia, Heart rate increased, Hypertension — Feeling: Fair · Be unable to do your normal daily activities

Free text: Rapid heart rate 101. High blood pressure 166 over 84 Abdominal pain left slbbow hurts

MedDRA releases: 2024-11 · check-in free text available
2022-04-04
Dose 4 — Moderna
2022-04-13
Survey response — 6 months, dose 3
MedDRA: Constipation — Feeling: Fair · Be unable to do your normal daily activities

Free text: I got a second booster 11 days ago. I have gotten severely constipated 3 times

MedDRA releases: 2024-11 · check-in free text available
2022-04-21
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-04-27
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-05-02
Survey response — day 28, dose 4
MedDRA: Abdominal pain, Asthenia, Constipation — Feeling: Fair · Be unable to do your normal daily activities

Free text: Since my second booster I have been severely constipated 4 separate times. With actual pain in my abdomen. I occurred to me because I never get constipated. The pain is debilitating from 15 to 45 minutes

MedDRA releases: 2024-11 · check-in free text available
2022-05-11
Survey response — day 35, dose 4
MedDRA: Abdominal pain, Dizziness — Feeling: Fair · Be unable to do your normal daily activities

Free text: Abdominal pain. Light headed

MedDRA releases: 2024-11 · check-in free text available
2022-05-16
Survey response — day 42, dose 4
MedDRA: Abdominal pain, Dizziness — Feeling: Fair · Be unable to do your normal daily activities

Free text: Abdominal pain. Light headed.

MedDRA releases: 2024-11 · check-in free text available
2022-07-04
Survey response — 3 months, dose 4
MedDRA: Abdominal pain, Headache, Myalgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Abdominal pain. Muscle pain. Headache

MedDRA releases: 2024-11 · check-in free text available
2022-10-04
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-04
Survey response — 12 months, dose 4
MedDRA: COVID-19 — Feeling: Good

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-10	Moderna	No
2	2021-03-10	Moderna	No
3	2021-10-13	Moderna	No
4	2022-04-04	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 10 — days 1–6 daily, dose 3

2021-10-14

Systemic reaction (other): My elbows are tender

2021-10-18

Systemic reaction (other): Left knee sharp pain under my knee cap. Same kind of pain I had in my hips after March 10 second dose of Maderna

2021-10-19

Systemic reaction (other): Left knee sharp pain. I have never had knee pain

Release 10 — day 21, dose 3

2021-11-05

Symptoms: Like when I got my second shot the booster now has my right hip hurting 1 to 10 a 7. I have abdominal pain and my legs ache my elbows hurt. I am 67 and retired

Release 10 — day 42, dose 3

2021-11-26

Symptoms: Sore throat. Taste. Fatigue abdominal pain

Release 10 — 3 months, dose 3

2022-01-12

Symptoms: Rapid heart rate 101. High blood pressure 166 over 84 Abdominal pain left slbbow hurts

Release 11 — 6 months, dose 3

2022-04-13

Symptoms: I got a second booster 11 days ago. I have gotten severely constipated 3 times

Release 11 — day 28, dose 4

2022-05-02

Symptoms: Since my second booster I have been severely constipated 4 separate times. With actual pain in my abdomen. I occurred to me because I never get constipated. The pain is debilitating from 15 to 45 minutes

Release 11 — day 35, dose 4

2022-05-11

Symptoms: Abdominal pain. Light headed

Release 11 — day 42, dose 4

2022-05-16

Symptoms: Abdominal pain. Light headed.

Release 12 — 3 months, dose 4

2022-07-04

Symptoms: Abdominal pain. Muscle pain. Headache

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	Abdominal pain	·	·	✓
SD	Arthralgia	·	·	✓
SD	Asthenia	·	·	✓
SD	Constipation	·	·	✓
SD	COVID-19	·	·	✓
SD	Dizziness	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Heart rate increased	·	·	✓
SD	Hypertension	·	·	✓
SD	Myalgia	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Vaccine positive rechallenge	·	·	✓
SRO	Arthralgia	·	·	✓
SRO	Tenderness	·	·	✓

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