4KJ-30845-28646

2 vaccinations 8 coded responses 16 check-ins 8 free-text entries 4 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 577 / SD
Registered: 2021-01-06

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Possible VAERS report

VAERS ID	Confidence	Score	Runner-up	Shared symptoms	Dose	State	VAERS vaccinated / onset / received	Call case
1209308 (opens in a new window)	high	10 / 11	—	4 of 10 VAERS symptoms	same dose (1)	SD matches	2021-01-06 / 2021-01-07 / 2021-04-14 received the same day as the last call	case 117786

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

2021-01-06
Registered in v-safe
2021-01-06
Dose 1 — Moderna
2021-01-06
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-07
Survey response — days 1–6 daily, dose 1
MedDRA: Insomnia, Nasal discomfort — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Slight burning sensation on top of both nostrils. 2) went to sleep at 11pm and awoke at 11:45pm feeling like I'd slept all night

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-15
Survey response — day 7, dose 1
MedDRA: Rhinorrhoea, Sinus congestion — Feeling: Fair · Headache

Free text: Runny nose, sinus congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Survey response — day 14, dose 1
MedDRA: Nasal congestion, Rhinorrhoea — Feeling: Poor

Free text: Extreme nasal congestion and runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Survey response — day 21, dose 1
MedDRA: Epistaxis — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Epistaxis. Sun night. Needed to go to ER to stop bleeding. Never experienced a nose bleed like that before.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-10
Dose 2 — Moderna
2021-02-17
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-24
Health check-in — day 14, dose 2
Feeling: Good

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

Adult check-in
2021-03-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-25
Survey response — day 42, dose 2
MedDRA: Headache, Seasonal allergy, Sinus congestion, Sneezing — Feeling: Fair

Free text: Sinus congestion & sneezing. Feels like seasonal allergies. Headache too

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Call 1 — Requested Callback
2021-04-13
Callback requested for
04:30P EST
2021-04-14
Call successful
Completed over the phone
2021-05-12
Survey response — 3 months, dose 2
MedDRA: Antibody test positive, Diverticulitis, Haemoglobin decreased, Haemolytic anaemia, Hospitalisation — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Diverticulitis. Low Hemoglobin. Referred for blood infusion on 5/4. Unable to due to higher antibodies. Hospitalized 5/4-5/7. Diagnosed with Hemolytic Anemia. Being treated with 100mg prednisone. Referred to (b)(6) Hematology

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
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)
2021-08-11
Survey response — 6 months, dose 2
MedDRA: Autoimmune haemolytic anaemia — 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: Diagnosed with Autoimmune Hemolytic Anemia May 5, 2021, possibly COVID 19 related

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-11
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)
2021-08-13
Call 1 — Requested Callback
2021-08-19
Call 2 — Left Voicemail
2021-08-20
Call 3 — Requested Callback
2021-08-24
Callback requested for
11:00AM ET
2021-08-25
Call successful
Participant prefers to complete VAERS report online
2022-02-10
Survey response — 12 months, dose 2
MedDRA: Autoimmune haemolytic anaemia, Office visit — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Possible nerve/muscle disease per neurological evaluation at (b)(6) in Aug 2021 with referral to (b)(6) Clinic in Feb 2022 Diagnosed with autoimmune hemolytic anemia in May 2021 with relapse in Oct 2021

MedDRA releases: 2024-11 · check-in free text available
2022-02-10
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-02-14
Call 1 — Requested Callback
2022-02-21
Callback requested for
05:00PM ET
2022-02-22
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-06	Moderna
2	2021-02-10	Moderna

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 1 — days 1–6 daily, dose 1

2021-01-07

Systemic reaction (other): Slight burning sensation on top of both nostrils. 2) went to sleep at 11pm and awoke at 11:45pm feeling like I'd slept all night

Release 2 — day 7, dose 1

2021-01-15

Systemic reaction (other): Runny nose, sinus congestion

Release 2 — day 14, dose 1

2021-01-21

Symptoms: Extreme nasal congestion and runny nose

Release 2 — day 21, dose 1

2021-01-27

Symptoms: Epistaxis. Sun night. Needed to go to ER to stop bleeding. Never experienced a nose bleed like that before.

Release 6 — day 42, dose 2

2021-03-25

Symptoms: Sinus congestion & sneezing. Feels like seasonal allergies. Headache too

Release 8 — 3 months, dose 2

2021-05-12

Symptoms: Diverticulitis. Low Hemoglobin. Referred for blood infusion on 5/4. Unable to due to higher antibodies. Hospitalized 5/4-5/7. Diagnosed with Hemolytic Anemia. Being treated with 100mg prednisone. Referred to (b)(6) Hematology

redacted (b)(6)

Release 9 — 6 months, dose 2

2021-08-11

Symptoms: Diagnosed with Autoimmune Hemolytic Anemia May 5, 2021, possibly COVID 19 related

Release 11 — 12 months, dose 2

2022-02-10

Symptoms: Possible nerve/muscle disease per neurological evaluation at (b)(6) in Aug 2021 with referral to (b)(6) Clinic in Feb 2022 Diagnosed with autoimmune hemolytic anemia in May 2021 with relapse in Oct 2021

redacted (b)(6)

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	Antibody test positive	✓	✓	✓
SD	Autoimmune haemolytic anaemia	✓	·	✓
SD	Diverticulitis	✓	✓	✓
SD	Epistaxis	✓	✓	✓
SD	Haemoglobin decreased	✓	✓	✓
SD	Haemolytic anaemia	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Nasal congestion	✓	✓	✓
SD	Office visit	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Seasonal allergy	✓	✓	✓
SD	Sinus congestion	✓	✓	✓
SD	Sneezing	✓	✓	✓
SRO	Burning sensation	○	○	○
SRO	Insomnia	✓	✓	✓
SRO	Nasal discomfort	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sinus congestion	✓	✓	✓
SRO	Sleep disorder	○	○	○

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