5A7-51896-83141

2 vaccinations 13 coded responses 26 check-ins 12 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 329 / FL
Registered: 2021-03-14

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

2021-03-12
Dose 1 — Moderna
2021-03-14
Registered in v-safe
2021-03-14
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling abnormal — Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Felt foggy mentally

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good · Site: Pain, Swelling

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-26
Survey response — day 14, dose 1
MedDRA: Immunisation reaction, Malaise, Mobility decreased, Petechiae, Pruritus — Feeling: Fair · Be unable to do your normal daily activities

Free text: Began with itch day 8, and general malaise. Day 9 had COVID arm. Day 10 had PETECHIAE lower extremities. Day 12 was first sign of slight improvement, but noted increased PETECHIAE, and felt physically restricted.

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

Adult check-in
2021-04-09
Survey response — day 28, dose 1
MedDRA: Migraine, Telemedicine, Vertigo — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Began with Vertigo Two days ago. Experienced two episodes of migraine headaches within one week. · Healthcare visit (other): In office visit with my Internest.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Report sent to call center — day 28, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-16
Survey response — day 35, dose 1
MedDRA: Extrasystoles, Fatigue, Nervousness, Vertigo — Feeling: Fair · Be unable to do your normal daily activities

Free text: Nerves are more on edge. Noticed increase in ectopic heart beats at times. Easy fatigability. Mild vertigo with movement.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — day 42, dose 1
Feeling: Fair

Adult check-in
2021-06-11
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-09-10
Survey response — 6 months, dose 1
MedDRA: Balance disorder, Cognitive disorder — Feeling: Fair · Be unable to do your normal daily activities

Free text: Mild cognitive change and unsteadiness on ambulatory.

MedDRA releases: 2024-11 · check-in free text available
2022-03-12
Health check-in — 12 months, dose 1
Feeling: Good

Adult check-in
2022-03-24
Call 1 — Left Voicemail
2022-09-28
Dose 2 — Novavax
2022-09-29
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain, Redness

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2022-09-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling · Headache

Adult check-in
2022-10-01
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain, Redness, Swelling

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2022-10-03
Survey response — days 1–6 daily, dose 2
MedDRA: Cutaneous vasculitis — Feeling: Good

Free text: No, I'm currently making careful observations until I have passed at least 10 days post vaccination since I experienced a cutaneous small vessel vasculitis after one Moderna vaccine.

MedDRA releases: 2024-11 · check-in free text available
2022-10-04
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good

Free text: No, only waiting for the 10 days post vaccine to pass uneventfully.

MedDRA releases: 2024-11 · check-in free text available
2022-10-05
Survey response — day 7, dose 2
MedDRA: No adverse event — Feeling: Good

Free text: No, just observing until 10 days post vaccine for any adverse reactions. October 8th will be 10 days.

MedDRA releases: 2024-11 · check-in free text available
2022-10-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2022-10-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2022-10-26
Survey response — day 28, dose 2
MedDRA: Erythema, Pain, Swelling — Feeling: Good · Be unable to work or attend school

Free text: I received my second Novavax vaccine on 10/21/22. I had moderate swelling, erythema, and soreness after 2 days that has since resolved. In fact, I had a Flu shot on 10/24/22 with similar symptoms, but they were only mild.

MedDRA releases: 2024-11 · check-in free text available
2022-11-03
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2022-11-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2022-12-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2023-03-29
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Back pain, Musculoskeletal stiffness, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-03-29
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)
2023-03-30
Call 2 — Left Voicemail
2023-03-30
Call 1 — Left Voicemail
2023-03-30
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2023-03-30
Call successful
Not applicable - Accidental Reporting

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-12	Moderna
2	2022-09-28	Novavax	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-09	Successful 2023-03-30	Reported to VAERS voluntarily prior to GDIT contact
2023-03-29	Successful 2023-03-30	Not applicable - Accidental Reporting

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-14

Systemic reaction (other): Felt foggy mentally

2021-03-15

Systemic reaction (other): No

Release 6 — day 14, dose 1

2021-03-26

Symptoms: Began with itch day 8, and general malaise. Day 9 had COVID arm. Day 10 had PETECHIAE lower extremities. Day 12 was first sign of slight improvement, but noted increased PETECHIAE, and felt physically restricted.

Release 7 — day 28, dose 1

2021-04-09

Symptoms: Began with Vertigo Two days ago. Experienced two episodes of migraine headaches within one week.

Healthcare visit (other): In office visit with my Internest.

Release 7 — day 35, dose 1

2021-04-16

Symptoms: Nerves are more on edge. Noticed increase in ectopic heart beats at times. Easy fatigability. Mild vertigo with movement.

Release 9 — 6 months, dose 1

2021-09-10

Symptoms: Mild cognitive change and unsteadiness on ambulatory.

Release 12 — days 1–6 daily, dose 2

2022-09-29

Systemic reaction (other): No

2022-10-01

Systemic reaction (other): No

2022-10-03

Systemic reaction (other): No, I'm currently making careful observations until I have passed at least 10 days post vaccination since I experienced a cutaneous small vessel vasculitis after one Moderna vaccine.

2022-10-04

Systemic reaction (other): No, only waiting for the 10 days post vaccine to pass uneventfully.

Release 12 — day 7, dose 2

2022-10-05

Systemic reaction (other): No, just observing until 10 days post vaccine for any adverse reactions. October 8th will be 10 days.

Release 12 — day 28, dose 2

2022-10-26

Symptoms: I received my second Novavax vaccine on 10/21/22. I had moderate swelling, erythema, and soreness after 2 days that has since resolved. In fact, I had a Flu shot on 10/24/22 with similar symptoms, but they were only mild.

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	Office visit	·	·	✓
HCVO	Telemedicine	✓	✓	✓
SD	Arthralgia	·	·	✓
SD	Back pain	·	·	✓
SD	Balance disorder	·	·	✓
SD	Cognitive disorder	·	·	✓
SD	Erythema	·	·	✓
SD	Extrasystoles	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Immunisation reaction	✓	✓	✓
SD	Malaise	✓	✓	✓
SD	Migraine	✓	✓	✓
SD	Mobility decreased	✓	✓	✓
SD	Musculoskeletal stiffness	·	·	✓
SD	Nervousness	✓	✓	✓
SD	Pain	·	·	✓
SD	Petechiae	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Swelling	·	·	✓
SD	Vertigo	✓	✓	✓
SRO	Cutaneous vasculitis	·	·	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	No adverse event	✓	✓	✓

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