5AF-16353-50917

4 vaccinations 12 coded responses 41 check-ins 10 free-text entries 2 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 871 / NM
Registered: 2021-03-09

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

2021-03-09
Registered in v-safe
2021-03-09
Dose 1 — Moderna
2021-03-09
Survey response — day 0, dose 1
MedDRA: Injection site pain — Feeling: Good

Free text: Slight tenderness of muscle in area of injection

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

Free text: My sleeping pulse was 5 or 6 bpm higher than normal.

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

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-06
Dose 2 — Moderna
2021-04-06
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · Fever · None

Adult check-in
2021-04-09
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Headache, Fatigue or tiredness, Nausea · Be unable to work

Free text: Slight Dissiness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Survey response — days 1–6 daily, dose 2
MedDRA: Body temperature decreased — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Low temperature, 95.9 Ferinheit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Headache, Joint pains, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-04-13
Health check-in — day 7, dose 2
Feeling: Good · Headache

Adult check-in
2021-04-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-06
Survey response — 3 months, dose 2
MedDRA: Hypersomnia — Feeling: Good

Free text: I sleep more, about 1/2 hour to 1 hour a day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-05
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-21
Dose 3 — Moderna
2021-12-28
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2022-01-04
Survey response — day 14, dose 3
MedDRA: Fatigue, Hypersomnia — Feeling: Good

Free text: I am slightly tired and fall asleep when not active. Sleeping 9 hours a night instead of usual 7 hours.

MedDRA releases: 2024-11 · check-in free text available
2022-01-11
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-18
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-25
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-02-01
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-22
Survey response — 3 months, dose 3
MedDRA: Fatigue, Headache, Hypersomnia, Pyrexia — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Slight fever, very tired, slept most of last Thursday, slight head ache.

MedDRA releases: 2024-11 · check-in free text available
2022-06-21
Survey response — 6 months, dose 3
MedDRA: Acupuncture, Dystonia, Fatigue, Headache, Tremor — 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

Free text: Symptoms: Head Aches, tremors, distonia Fatigue after exercise · Healthcare visit (other): Acupuncture treatment

MedDRA releases: 2024-11 · check-in free text available
2022-06-21
Report sent to call center — 6 months, 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

1 call case(s)
2022-06-22
Call successful
Does not wish to fill out VAERS report
2022-10-05
Dose 4 — Pfizer-BioNTech
2022-10-09
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-10
Survey response — days 1–6 daily, dose 4
MedDRA: Flushing — Feeling: Good · Fever

Free text: Face flush

MedDRA releases: 2024-11 · check-in free text available
2022-10-11
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache, Diarrhea

Adult check-in
2022-10-12
Health check-in — day 7, dose 4
Feeling: Good · Diarrhea

Adult check-in
2022-10-19
Survey response — day 14, dose 4
MedDRA: Corneal opacity, Diarrhoea, Irritability, Pre-existing disease, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Diarea, irritation in old shingles area. Corneal haze in eye affected by shingles got worse. · Healthcare visit (other): Eye care

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Report sent to call center — day 14, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-10-20
Call 1 — Left Voicemail
2022-10-28
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-02
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-10
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-16
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2023-01-04
Survey response — 3 months, dose 4
MedDRA: Fatigue, Headache, Oropharyngeal pain, Pyrexia, Sinus congestion — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-04-05
Survey response — 6 months, dose 4
MedDRA: Fatigue, Tremor — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-09	Moderna
2	2021-04-06	Moderna
3	2021-12-21	Moderna	No
4	2022-10-05	Pfizer-BioNTech	No

Call center

2 call center cases

1 successful · 1 unsuccessful

See the call center timeline

Free text

Release 5 — day 0, dose 1

2021-03-09

Systemic reaction (other): Slight tenderness of muscle in area of injection

Release 5 — days 1–6 daily, dose 1

2021-03-10

Systemic reaction (other): My sleeping pulse was 5 or 6 bpm higher than normal.

Release 7 — days 1–6 daily, dose 2

2021-04-09

Systemic reaction (other): Slight Dissiness

2021-04-10

Systemic reaction (other): Low temperature, 95.9 Ferinheit

Release 9 — 3 months, dose 2

2021-07-06

Symptoms: I sleep more, about 1/2 hour to 1 hour a day.

Release 10 — day 14, dose 3

2022-01-04

Symptoms: I am slightly tired and fall asleep when not active. Sleeping 9 hours a night instead of usual 7 hours.

Release 11 — 3 months, dose 3

2022-03-22

Symptoms: Slight fever, very tired, slept most of last Thursday, slight head ache.

Release 12 — 6 months, dose 3

2022-06-21

Symptoms: Head Aches, tremors, distonia Fatigue after exercise

Healthcare visit (other): Acupuncture treatment

Release 12 — days 1–6 daily, dose 4

2022-10-10

Systemic reaction (other): Face flush

Release 12 — day 14, dose 4

2022-10-19

Symptoms: Diarea, irritation in old shingles area. Corneal haze in eye affected by shingles got worse.

Healthcare visit (other): Eye care

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	Acupuncture	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Corneal opacity	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Dystonia	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Hypersomnia	✓	✓	✓
SD	Irritability	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Sinus congestion	·	·	✓
SD	Somnolence	·	·	○
SD	Tremor	·	·	✓
SRO	Body temperature decreased	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Flushing	·	·	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Injection site pain	✓	✓	✓

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