4VU-16397-57377

4 vaccinations 16 coded responses 42 check-ins 15 free-text entries 6 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 917 / CA
Registered: 2021-02-04

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

2021-02-04
Registered in v-safe
2021-02-04
Dose 1 — Moderna
2021-02-04
Survey response — day 0, dose 1
MedDRA: Fatigue — Feeling: Fair · Muscle or body aches

Free text: Very tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Fair · Fatigue or tiredness

Free text: Tired all day

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-18
Survey response — day 14, dose 1
MedDRA: Asthma, Fatigue, Wheezing — Feeling: Fair · Be unable to do your normal daily activities

Free text: Very tired and asthma with wheezing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-04
Dose 2 — Moderna
2021-03-04
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

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

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal discomfort — Feeling: Fair · Fatigue or tiredness

Free text: Upset stomach

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Survey response — day 14, dose 2
MedDRA: Hypersensitivity, Sinus pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Severe allergies and sinus pain. Fever of 99.2

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Survey response — day 21, dose 2
MedDRA: Sinusitis — Feeling: Good · Be unable to do your normal daily activities

Free text: Sinus infection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — day 28, dose 2
MedDRA: Fatigue, Malaise, Viral infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: Very tired and feel as if infected with a virus.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-03
Survey response — 3 months, dose 2
MedDRA: Bronchitis, Medical counselling, Sinusitis — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Sinus infections and bronchitis. · Healthcare visit (other): Telephone

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-03
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-02
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-03-05
Survey response — 12 months, dose 2
MedDRA: Asthma, Bronchitis, Cough — Feeling: Fair · 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: Asthma and bronchitis and persistent cough

MedDRA releases: 2024-11 · check-in free text available
2022-03-05
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-03-07
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-03-07
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-24
Dose 3 — Moderna
2022-04-24
Health check-in — day 0, dose 3
Feeling: Good · Site: Redness · Fever · Joint pains, Fatigue or tiredness

Adult check-in
2022-04-25
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Good · Joint pains, Fatigue or tiredness

Free text: None

MedDRA releases: 2024-11 · check-in free text available
2022-04-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-28
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Nausea

Free text: None

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2022-04-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2022-05-01
Survey response — day 7, dose 3
MedDRA: Asthma — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: Asthma symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-05-08
Survey response — day 14, dose 3
MedDRA: Pneumonia — Feeling: Fair · 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: Pneumonia

MedDRA releases: 2024-11 · check-in free text available
2022-05-08
Report sent to call center — day 14, 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 · 1 call case(s)
2022-05-09
Call successful
Not applicable - Accidental Reporting
2022-05-15
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-05-22
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-05-29
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-06-05
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-06-14
Dose 4 — Moderna
2022-07-25
Survey response — 3 months, dose 3
MedDRA: Disturbance in attention, Fatigue, Insomnia, Muscle spasms — 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: Severe muscle cramps that don't abate. Difficulty sleeping and fatigue. Difficulty in concentrating.

MedDRA releases: 2024-11 · check-in free text available
2022-07-25
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 · 1 call case(s)
2022-07-26
Call successful
Participant prefers to complete VAERS report online
2022-09-13
Survey response — 3 months, dose 4
MedDRA: Asthma, Sinusitis — Feeling: Fair · 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: Sinusitis and increasing asthma

MedDRA releases: 2024-11 · check-in free text available
2022-09-13
Report sent to call center — 3 months, 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 · 1 call case(s)
2022-09-14
Call successful
Does not wish to fill out VAERS report
2022-12-13
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2023-06-14
Survey response — 12 months, dose 4
MedDRA: Asthma, Fatigue, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-06-14
Call case (no matching report) — Unsuccessful
2023-06-15
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna
2	2021-03-04	Moderna
3	2022-04-24	Moderna	No
4	2022-06-14	Moderna	No

Call center

6 call center cases

5 successful · 1 unsuccessful

See the call center timeline

Free text

Release 3 — day 0, dose 1

2021-02-04

Systemic reaction (other): Very tired

Release 3 — days 1–6 daily, dose 1

2021-02-09

Systemic reaction (other): Tired all day

Release 4 — day 14, dose 1

2021-02-18

Symptoms: Very tired and asthma with wheezing

Release 5 — days 1–6 daily, dose 2

2021-03-09

Systemic reaction (other): Upset stomach

Release 5 — day 14, dose 2

2021-03-18

Symptoms: Severe allergies and sinus pain. Fever of 99.2

Release 6 — day 21, dose 2

2021-03-25

Symptoms: Sinus infection.

Release 6 — day 28, dose 2

2021-04-01

Symptoms: Very tired and feel as if infected with a virus.

Release 8 — 3 months, dose 2

2021-06-03

Symptoms: Sinus infections and bronchitis.

Healthcare visit (other): Telephone

Release 11 — 12 months, dose 2

2022-03-05

Symptoms: Asthma and bronchitis and persistent cough

Release 11 — days 1–6 daily, dose 3

2022-04-25

Systemic reaction (other): None

2022-04-28

Systemic reaction (other): None

Release 11 — day 7, dose 3

2022-05-01

Systemic reaction (other): Asthma symptoms

Release 11 — day 14, dose 3

2022-05-08

Symptoms: Pneumonia

Release 12 — 3 months, dose 3

2022-07-25

Symptoms: Severe muscle cramps that don't abate. Difficulty sleeping and fatigue. Difficulty in concentrating.

Release 12 — 3 months, dose 4

2022-09-13

Symptoms: Sinusitis and increasing asthma

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	Medical counselling	✓	✓	✓
SD	Asthma	✓	✓	✓
SD	Bronchitis	✓	✓	✓
SD	Cough	·	·	✓
SD	Disturbance in attention	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Insomnia	·	·	✓
SD	Malaise	✓	·	✓
SD	Muscle spasms	·	·	✓
SD	Pneumonia	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Sinus pain	✓	✓	✓
SD	Sinusitis	✓	✓	✓
SD	Viral infection	○	✓	○
SD	Wheezing	✓	✓	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Asthma	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	No adverse event	·	·	✓

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