5JC-93262-92193

4 vaccinations 8 coded responses 34 check-ins 8 free-text entries 3 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 483 / MI
Registered: 2021-01-16

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

2021-01-14
Dose 1 — Moderna
2021-01-16
Registered in v-safe
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Poor quality sleep — Feeling: Good · Fatigue or tiredness

Free text: Havent slept well since getting vaccinated

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Survey response — day 14, dose 1
MedDRA: Asthenia, Insomnia, Oropharyngeal pain, Sinus headache — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Have had sore throat, sinus and headache for last 3 or 4 days. Lack of energy, trouble sleeping. No fever or temperature.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Survey response — day 21, dose 1
MedDRA: Cough, Oropharyngeal pain, Paranasal sinus hypersecretion — Feeling: Fair

Free text: Sore throat, sinus drainage and coughing the last several days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Dose 2 — Moderna
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-06
Survey response — day 21, dose 2
MedDRA: Cough, Headache, Influenza like illness, Nasopharyngitis, Oropharyngeal pain — Feeling: Fair

Free text: Cold or mild flu like symptoms, sore throat, dry cough, headache for about two days. Yesterday was the worst I feel some better today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-15
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-14
Survey response — 6 months, dose 2
MedDRA: Injection site erythema, Injection site pain, Injection site pustule, Injection site scab — Feeling: Good

Free text: Nothing of concern but the injection site of the first shot recently developed a sore red pimple like spot that has persisted for about 6 or 7 weeks. Its not painful but it is tender to the touch. It has scabbed in the last week.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-22
Dose 3 — Moderna
2021-10-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-10-27
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-03
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-22
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-23
Survey response — 6 months, dose 3
MedDRA: Influenza virus test negative, Nasopharyngitis, SARS-CoV-2 test negative, Sinusitis, Upper respiratory tract infection — 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 · Outpatient clinic or urgent care clinic visit

Free text: Upper respiratory and sinus infection, worst cold I can remember having. Tested negative for COVID and flu. Took a week to get back to normal

MedDRA releases: 2024-11 · check-in free text available
2022-03-23
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-24
Call 1 — Left Voicemail
2022-03-24
Call successful
Does not wish to fill out VAERS report
2022-04-01
Dose 4 — Moderna
2022-04-15
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-26
Survey response — day 21, dose 4
MedDRA: Cough, Laboratory test abnormal, Medical counselling, Oropharyngeal pain, Sinus pain — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional

Free text: Symptoms: I've had a cough, mild sore throat and sinus for r the last couple of days but normal temperature. I performed a self test today and it came back a strong positive. · Healthcare visit (other): Spoke with my Dr. by phone

MedDRA releases: 2024-11 · check-in free text available
2022-04-26
Report sent to call center — day 21, dose 4
Be unable to work or attend school · Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-27
Call successful
Participant prefers to complete VAERS report online
2022-04-29
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-08
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-13
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-01
Survey response — 3 months, dose 4
MedDRA: Nasopharyngitis, SARS-CoV-2 test positive — Feeling: Good · 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: Positive COVID test late April. Mild to moderate cold like symptoms with 1 or 2 days moderate to bad. Overall lasted 4 or 5 days but it took a full month before I no longer had any affects at all.

MedDRA releases: 2024-11 · check-in free text available
2022-07-01
Report sent to call center — 3 months, dose 4
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)
2022-07-05
Call 2 — Left Voicemail
2022-07-05
Call 1 — Left Voicemail
2022-07-05
Call 1 — Left Voicemail
2022-07-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-03
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-01
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-11	Moderna
3	2021-09-22	Moderna	No
4	2022-04-01	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-19

Systemic reaction (other): Havent slept well since getting vaccinated

Release 2 — day 14, dose 1

2021-01-28

Symptoms: Have had sore throat, sinus and headache for last 3 or 4 days. Lack of energy, trouble sleeping. No fever or temperature.

Release 3 — day 21, dose 1

2021-02-04

Symptoms: Sore throat, sinus drainage and coughing the last several days.

Release 5 — day 21, dose 2

2021-03-06

Symptoms: Cold or mild flu like symptoms, sore throat, dry cough, headache for about two days. Yesterday was the worst I feel some better today.

Release 9 — 6 months, dose 2

2021-08-14

Symptoms: Nothing of concern but the injection site of the first shot recently developed a sore red pimple like spot that has persisted for about 6 or 7 weeks. Its not painful but it is tender to the touch. It has scabbed in the last week.

Release 11 — 6 months, dose 3

2022-03-23

Symptoms: Upper respiratory and sinus infection, worst cold I can remember having. Tested negative for COVID and flu. Took a week to get back to normal

Release 11 — day 21, dose 4

2022-04-26

Symptoms: I've had a cough, mild sore throat and sinus for r the last couple of days but normal temperature. I performed a self test today and it came back a strong positive.

Healthcare visit (other): Spoke with my Dr. by phone

Release 12 — 3 months, dose 4

2022-07-01

Symptoms: Positive COVID test late April. Mild to moderate cold like symptoms with 1 or 2 days moderate to bad. Overall lasted 4 or 5 days but it took a full month before I no longer had any affects at all.

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	Medical counselling	·	·	✓
SD	Asthenia	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Influenza like illness	✓	✓	✓
SD	Influenza virus test negative	·	·	✓
SD	Injection site erythema	✓	·	✓
SD	Injection site pain	✓	·	✓
SD	Injection site pustule	✓	·	✓
SD	Injection site scab	✓	·	✓
SD	Insomnia	✓	✓	✓
SD	Laboratory test abnormal	·	·	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Paranasal sinus hypersecretion	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sinus headache	✓	✓	✓
SD	Sinus pain	·	·	✓
SD	Sinusitis	·	·	✓
SD	Upper respiratory tract infection	·	·	✓
SRO	Poor quality sleep	✓	✓	✓

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