5AR-63919-58229

5 vaccinations 12 coded responses 34 check-ins 11 free-text entries 5 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 440 / OH
Registered: 2021-03-12

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

2021-02-08
Dose 1 — Moderna
2021-03-08
Dose 2 — Moderna
2021-03-12
Registered in v-safe
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-15
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-24
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-29
Health check-in — day 21, dose 2
Feeling: Good

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

Adult check-in
2021-04-13
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-20
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-07
Survey response — 3 months, dose 2
MedDRA: Ageusia, Anosmia — Feeling: Fair

Free text: Loss of smell and taste since my 2nd Moderna vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-26
Dose 3 — Moderna
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-02
Health check-in — day 7, dose 3
Feeling: Good · Chills, Fatigue or tiredness

Adult check-in
2021-11-09
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-16
Survey response — day 21, dose 3
MedDRA: Headache — Feeling: Good · Be unable to do your normal daily activities

Free text: Predawn to bedtime headache.

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Survey response — day 28, dose 3
MedDRA: Headache — Feeling: Fair

Free text: Headaches

MedDRA releases: 2024-11 · check-in free text available
2021-11-30
Survey response — day 35, dose 3
MedDRA: Headache — Feeling: Fair

Free text: Headaches

MedDRA releases: 2024-11 · check-in free text available
2021-12-07
Health check-in — day 42, dose 3
Feeling: Good

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

Adult check-in
2022-03-31
Dose 4 — Moderna
2022-04-19
Survey response — day 14, dose 4
MedDRA: Emergency care, Office visit, Toothache — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Tooth ache. · Healthcare visit (other): Dentist urgent care

MedDRA releases: 2024-11 · check-in free text available
2022-04-19
Report sent to call center — day 14, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-21
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-22
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-04-28
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-05
Survey response — day 35, dose 4
MedDRA: Ligament pain, Office visit, Physiotherapy, Tendon pain — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Tendon and ligament pain in left forearm aÃ±d bicep requiring physÃ¬cal therapy · Healthcare visit (other): PrÃ¬mary care physcÃ¬an

MedDRA releases: 2024-11 · check-in free text available
2022-05-05
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-06
Call 1 — Left Voicemail
2022-05-12
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-02
Survey response — 3 months, dose 4
MedDRA: Gastrointestinal viral infection, Influenza — 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: Had 4 days of gastro-intestinal flu June 11-14 even with vaccination. Have not had influenza in 15-20 years.

MedDRA releases: 2024-11 · check-in free text available
2022-07-02
Report sent to call center — 3 months, dose 4
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)
2022-07-05
Call 1 — Left Voicemail
2022-07-05
Call 2 — Left Voicemail
2022-07-05
Call 1 — Left Voicemail
2022-09-07
Dose 5 — Moderna
Co-administered: Flu
2022-09-16
Health check-in — day 7, dose 5
Feeling: Good · Diarrhea, Abdominal pain

Adult check-in
2022-09-22
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-09-30
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-10-05
Survey response — day 28, dose 5
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Tired all day long every day.

MedDRA releases: 2024-11 · check-in free text available
2022-10-13
Survey response — day 35, dose 5
MedDRA: Headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Near perpetual daily frontal lobe headaches for the last week.

MedDRA releases: 2024-11 · check-in free text available
2022-10-21
Survey response — day 42, dose 5
MedDRA: Headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Persistent frontral lobe headache continues.

MedDRA releases: 2024-11 · check-in free text available
2022-12-08
Survey response — 3 months, dose 5
MedDRA: Headache, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Stinging frontal lobe headaches · Healthcare visit (other): Primary care physician

MedDRA releases: 2024-11 · check-in free text available
2022-12-08
Report sent to call center — 3 months, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-12-09
Call successful
Participant prefers to complete VAERS report online
2022-12-09
Call successful
Participant prefers to complete VAERS report online
2022-12-09
Call successful
Participant prefers to complete VAERS report online
2023-03-08
Survey response — 6 months, dose 5
MedDRA: Atrial flutter — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-03-08
Report sent to call center — 6 months, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-03-09
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-08	Moderna
2	2021-03-08	Moderna
3	2021-10-26	Moderna	No
4	2022-03-31	Moderna	No
5	2022-09-07	Moderna	Flu

Call center

5 call center cases

4 successful · 1 unsuccessful

See the call center timeline

Free text

Release 8 — 3 months, dose 2

2021-06-07

Symptoms: Loss of smell and taste since my 2nd Moderna vaccine.

Release 10 — day 21, dose 3

2021-11-16

Symptoms: Predawn to bedtime headache.

Release 10 — day 28, dose 3

2021-11-25

Symptoms: Headaches

Release 10 — day 35, dose 3

2021-11-30

Symptoms: Headaches

Release 11 — day 14, dose 4

2022-04-19

Symptoms: Tooth ache.

Healthcare visit (other): Dentist urgent care

Release 11 — day 35, dose 4

2022-05-05

Symptoms: Tendon and ligament pain in left forearm aÃ±d bicep requiring physÃ¬cal therapy

Healthcare visit (other): PrÃ¬mary care physcÃ¬an

Release 12 — 3 months, dose 4

2022-07-02

Symptoms: Had 4 days of gastro-intestinal flu June 11-14 even with vaccination. Have not had influenza in 15-20 years.

Release 12 — day 28, dose 5

2022-10-05

Symptoms: Tired all day long every day.

Release 12 — day 35, dose 5

2022-10-13

Symptoms: Near perpetual daily frontal lobe headaches for the last week.

Release 12 — day 42, dose 5

2022-10-21

Symptoms: Persistent frontral lobe headache continues.

Release 12 — 3 months, dose 5

2022-12-08

Symptoms: Stinging frontal lobe headaches

Healthcare visit (other): Primary care physician

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	Emergency care	·	·	✓
HCVO	Office visit	·	·	✓
SD	Ageusia	✓	✓	✓
SD	Anosmia	✓	✓	✓
SD	Atrial flutter	·	·	✓
SD	Fatigue	·	·	✓
SD	Gastrointestinal viral infection	·	·	✓
SD	Headache	·	·	✓
SD	Influenza	·	·	✓
SD	Ligament pain	·	·	✓
SD	Physiotherapy	·	·	✓
SD	Tendon pain	·	·	✓
SD	Toothache	·	·	✓

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