5AQ-14675-65173

2 vaccinations 6 coded responses 17 check-ins 6 free-text entries 5 call cases

Sex: Male
Age at first dose: 36-40
ZIP prefix: 443 / OH
Registered: 2021-03-11

Relationship: Self
Race: Multiracial
Ethnicity: Hispanic or Latino

Timeline

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

2021-02-25
Dose 1 — Moderna
2021-03-11
Registered in v-safe
2021-03-11
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-25
Dose 2 — Moderna
2021-03-25
Health check-in — day 0, dose 2
Feeling: Fair · Fever · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-26
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Feeling abnormal — 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

Free text: Feeling "off" feeling weak

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · 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
2021-03-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-29
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Muscle or body aches

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-01
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Muscle or body aches

Adult check-in
2021-04-09
Survey response — day 14, dose 2
MedDRA: Central serous chorioretinopathy, Office visit — 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

Free text: Symptoms: Developed what my optometrist calls Central Serous Chorioretinopathy. It's a pita. Left eye and therefore vision overall feels like you are looking underwater. Never happened before and don't know if related. · Healthcare visit (other): Drs In-person visit with referral to a specialist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-15
Survey response — day 21, dose 2
MedDRA: Central serous chorioretinopathy, Office visit — 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: Symptoms: central serous chorioretinopathy · Healthcare visit (other): Drs referral to specialist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-24
Survey response — day 28, dose 2
MedDRA: Central serous chorioretinopathy, Office visit — 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

Free text: Symptoms: central serous retinopath · Healthcare visit (other): Office visit then specialist visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-30
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-23
Survey response — 6 months, dose 2
MedDRA: Abdominal tenderness, Asthenia, Cold sweat, Cough, Feeling of body temperature change, Gastrointestinal pain, Office visit, Rhinorrhoea, Sneezing — Feeling: Good · Be unable to work or attend school, 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: Symptoms: Recently had lower intestinal cramps that you couldn't touch w/o pain. After two days.....gone. Then I got sniffles, runny nose, cough (no congestion) feeling weak, sneezing, clammy, heating up and cooling down. All lasted 5 days · Healthcare visit (other): In person Dr visit

MedDRA releases: 2024-11 · check-in free text available
2021-09-23
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-09-26
Call 1 — Left Voicemail
2021-09-27
Call 2 — Left Voicemail
2021-09-30
Callback requested for
04:00PM ET
2021-10-05
Call successful
Participant prefers to complete VAERS report online
2022-03-25
Survey response — 12 months, dose 2
MedDRA: COVID-19, Mass, Office visit, Swelling — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Got Covid. Bump has formed under the back of my skull. Like a lump · Healthcare visit (other): Office visit and possible surgery

MedDRA releases: 2024-11 · check-in free text available
2022-03-25
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2022-03-28
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-25	Moderna
2	2021-03-25	Moderna

Call center

5 call center cases

1 successful · 4 unsuccessful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-26

Systemic reaction (other): Feeling "off" feeling weak

Release 7 — day 14, dose 2

2021-04-09

Symptoms: Developed what my optometrist calls Central Serous Chorioretinopathy. It's a pita. Left eye and therefore vision overall feels like you are looking underwater. Never happened before and don't know if related.

Healthcare visit (other): Drs In-person visit with referral to a specialist

Release 7 — day 21, dose 2

2021-04-15

Symptoms: central serous chorioretinopathy

Healthcare visit (other): Drs referral to specialist

Release 7 — day 28, dose 2

2021-04-24

Symptoms: central serous retinopath

Healthcare visit (other): Office visit then specialist visit

Release 9 — 6 months, dose 2

2021-09-23

Symptoms: Recently had lower intestinal cramps that you couldn't touch w/o pain. After two days.....gone. Then I got sniffles, runny nose, cough (no congestion) feeling weak, sneezing, clammy, heating up and cooling down. All lasted 5 days

Healthcare visit (other): In person Dr visit

Release 11 — 12 months, dose 2

2022-03-25

Symptoms: Got Covid. Bump has formed under the back of my skull. Like a lump

Healthcare visit (other): Office visit and possible surgery

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	✓	✓	✓
SD	Abdominal tenderness	·	·	✓
SD	Asthenia	·	·	✓
SD	Central serous chorioretinopathy	✓	✓	✓
SD	Cold sweat	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Feeling of body temperature change	·	·	✓
SD	Gastrointestinal pain	·	·	✓
SD	Mass	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Sneezing	·	·	✓
SD	Swelling	·	·	✓
SRO	Asthenia	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓

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