4SU-23047-09129

3 vaccinations 7 coded responses 42 check-ins 7 free-text entries 3 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 750 / TX
Registered: 2021-01-28

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-01-28
Registered in v-safe
2021-01-28
Dose 1 — Moderna
2021-01-28
Health check-in — day 0, dose 1
Feeling: Good · Fever · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-18
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-01
Dose 2 — Moderna
2021-03-01
Survey response — day 0, dose 2
MedDRA: Upper-airway cough syndrome — Feeling: Good · Fever

Free text: Post nasal secretions

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Rhinorrhoea — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Nasal secretions

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling · None

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · None

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-12
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-31
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-27
Dose 3 — Moderna
2021-10-27
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Chills, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Abdominal pain

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-03
Health check-in — day 7, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-11-11
Survey response — day 14, dose 3
MedDRA: Blood bilirubin increased, Faeces pale, Flatulence, Hepatic enzyme increased, Unevaluable event — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Flatulence Increase bilirrubina light stools and increase liver enzymes · Healthcare visit (other): Endoscopy US and stent

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Report sent to call center — day 14, dose 3
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 · no matching call case
2021-11-17
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-24
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-01
Survey response — day 35, dose 3
MedDRA: Abdominal pain, Pre-existing disease, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Abdominal pain and vomits do as pancreatitis autoimmune

MedDRA releases: 2024-11 · check-in free text available
2021-12-08
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-26
Survey response — 3 months, dose 3
MedDRA: Autoimmune pancreatitis, Emergency care — 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: Symptoms: I developed autoinmune pancreatitis following 5days after the Moderna booster · Healthcare visit (other): Emergency ERCP

MedDRA releases: 2024-11 · check-in free text available
2022-01-26
Report sent to call center — 3 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)
2022-01-27
Call 1 — Left Voicemail
2022-01-27
Call successful
Participant prefers to complete VAERS report online
2022-04-27
Survey response — 6 months, dose 3
MedDRA: Pancreatitis, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Flares of autoimmune pancreatitis

MedDRA releases: 2024-11 · check-in free text available
2022-04-27
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-29
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-10-27
Survey response — 12 months, dose 3
MedDRA: Autoimmune pancreatitis, Gastrointestinal disorder — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: I had developed autoimmune pancreatitis with use of azathioprine for one year and continue with episodic abdominal symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-10-27
Report sent to call center — 12 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-28
Call successful
Reported to VAERS voluntarily prior to GDIT contact

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-28	Moderna
2	2021-03-01	Moderna
3	2021-10-27	Moderna	No

Call center

3 call center cases

3 successful

VAERS report filed, before or during a call: 2

1 check-in flagged for a call with no call center case on record

See the call center timeline

Free text

Release 4 — day 0, dose 2

2021-03-01

Systemic reaction (other): Post nasal secretions

Release 4 — days 1–6 daily, dose 2

2021-03-02

Systemic reaction (other): Nasal secretions

Release 10 — day 14, dose 3

2021-11-11

Symptoms: Flatulence Increase bilirrubina light stools and increase liver enzymes

Healthcare visit (other): Endoscopy US and stent

Release 10 — day 35, dose 3

2021-12-01

Symptoms: Abdominal pain and vomits do as pancreatitis autoimmune

Release 11 — 3 months, dose 3

2022-01-26

Symptoms: I developed autoinmune pancreatitis following 5days after the Moderna booster

Healthcare visit (other): Emergency ERCP

Release 11 — 6 months, dose 3

2022-04-27

Symptoms: Flares of autoimmune pancreatitis

Release 12 — 12 months, dose 3

2022-10-27

Symptoms: I had developed autoimmune pancreatitis with use of azathioprine for one year and continue with episodic abdominal symptoms

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	Emergency care	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Abdominal pain	·	·	✓
SD	Autoimmune pancreatitis	·	·	✓
SD	Blood bilirubin increased	·	·	✓
SD	Faeces pale	·	·	✓
SD	Flatulence	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Hepatic enzyme increased	·	·	✓
SD	Pancreatitis	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Vomiting	·	·	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Upper-airway cough syndrome	✓	✓	✓

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