58B-10270-61792

2 vaccinations 13 coded responses 18 check-ins 13 free-text entries 3 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 313 / GA
Registered: 2021-03-16

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

2021-03-15
Dose 1 — Moderna
2021-03-16
Registered in v-safe
2021-03-16
Survey response — days 1–6 daily, dose 1
MedDRA: Eye irritation, Rhinorrhoea — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Running nose and burning vision

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Rhinorrhoea — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Running nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — days 1–6 daily, dose 1
MedDRA: Back pain, Rhinorrhoea — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Running nose and back pain as well

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — days 1–6 daily, dose 1
MedDRA: Back pain, Rhinorrhoea — Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Runny nose and back pain on the waist line

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-22
Health check-in — day 7, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-29
Survey response — day 14, dose 1
MedDRA: Anxiety, Fatigue, Pre-existing disease, Rhinorrhoea — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: My anxiety has worsen and I been tired more than usual. Also running nose..

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — day 21, dose 1
MedDRA: Fatigue, Influenza, Influenza like illness — Feeling: Fair

Free text: Flu symptoms and tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-04-15
Dose 2 — Moderna
2021-04-19
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Pain, Pain in extremity — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: All my left side from my shoulder down my leg bad pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Survey response — days 1–6 daily, dose 2
MedDRA: Ageusia, Rhinorrhoea — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · 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

Free text: Runny nose and no taste

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Report sent to call center — days 1–6 daily, 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)
2021-04-22
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-29
Survey response — day 14, dose 2
MedDRA: Fatigue, Muscular weakness — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Tiredness and weakness in my legs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Survey response — day 35, dose 2
MedDRA: Cough — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Coughing at night worse than ever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Survey response — day 42, dose 2
MedDRA: Fatigue, Headache, Pain — 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

Free text: Headaches and body pain also to tire out of doing nothing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Report sent to call center — day 42, 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)
2021-07-15
Survey response — 3 months, dose 2
MedDRA: Asthenia, Headache, Mood swings — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Headaches and mood swing also weaknesses

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-14
Survey response — 6 months, dose 2
MedDRA: Back pain, Chest discomfort, Chest pain, Headache, Nasal congestion — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Stuffy nose and continues headaches also like chest pain (pressure). Back pain as well

MedDRA releases: 2024-11 · check-in free text available
2022-03-09
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-15	Moderna
2	2021-04-15	Moderna

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-16

Systemic reaction (other): Running nose and burning vision

2021-03-18

Systemic reaction (other): Running nose

2021-03-19

Systemic reaction (other): Running nose and back pain as well

Release 6 — days 1–6 daily, dose 1

2021-03-20

Systemic reaction (other): Runny nose and back pain on the waist line

Release 6 — day 14, dose 1

2021-03-29

Symptoms: My anxiety has worsen and I been tired more than usual. Also running nose..

Release 6 — day 21, dose 1

2021-04-05

Symptoms: Flu symptoms and tiredness

Release 7 — days 1–6 daily, dose 2

2021-04-19

Systemic reaction (other): All my left side from my shoulder down my leg bad pain

2021-04-21

Systemic reaction (other): Runny nose and no taste

Release 8 — day 14, dose 2

2021-04-29

Symptoms: Tiredness and weakness in my legs

Release 8 — day 35, dose 2

2021-05-20

Symptoms: Coughing at night worse than ever

Release 8 — day 42, dose 2

2021-05-27

Symptoms: Headaches and body pain also to tire out of doing nothing

Release 9 — 3 months, dose 2

2021-07-15

Symptoms: Headaches and mood swing also weaknesses

Release 10 — 6 months, dose 2

2021-10-14

Symptoms: Stuffy nose and continues headaches also like chest pain (pressure). Back pain as well

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	Anxiety	✓	✓	✓
SD	Asthenia	✓	·	✓
SD	Back pain	·	·	✓
SD	Chest discomfort	·	·	✓
SD	Chest pain	·	·	✓
SD	Cough	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Influenza	·	·	✓
SD	Influenza like illness	✓	✓	○
SD	Mood swings	✓	·	✓
SD	Muscular weakness	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SRO	Ageusia	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Eye irritation	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓

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