5SM-25039-22125

2 vaccinations 5 coded responses 21 check-ins 5 free-text entries 3 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 499 / MI
Registered: 2021-01-27

Relationship: Self
Race: Asian
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-26
Dose 1 — Moderna
2021-01-27
Registered in v-safe
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-02
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-23
Dose 2 — Moderna
2021-02-23
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Diplopia, Dizziness, Fatigue, Headache, Myalgia, Nausea, Vertigo, Vomiting — Feeling: Poor · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Systemic reaction (other): Hospitalized on 2/25/2021, 2/26/2021, 2/27/2021, 2/28/2021 for severe dizziness, vertigo, and nausea; Collapsed on 2/25/2021; Severe dizziness and vertigo on 2/24/2021, 2/25/2021, 2/26/2021, 2/27/2021, 2/28/2021; Severe nausea on 2/25/2021; Mild nausea on 2/26/2021; Severe muscle and body aches on 2/24/2021, 2/25/2021, 2/26/2021; Moderate muscle and body aches on 2/27/2021; Severe fatigue or tiredness on 2/24/2021, 2/25/2021, 2/26/2021; Moderate fatigue or tiredness on 2/27/2021; Mild headache on 2/24/2021, 2/25/2021; Severe vomiting on 2/25/2021; Severe double vision on 2/26/2021 (Note: This whole report was dictated by me to be typed by my designee.) · Healthcare visit (other): Collapsed on 2/25/2021 and required EMT transport to Emergency Room and Hospitalized on 2/25/2021 until 2/28/2021 for severe dizziness, vertigo, and nausea.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Feeling abnormal, Hospitalisation, Vertigo, Vision blurred, Walking aid user — Feeling: Poor · Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Very dizzy when I move, vertigo, unable to focus vision, unstable walking (have to use walker), foggy brain · Healthcare visit (other): I will have follow-up visits with my physician and the physical therapist this week (follow-up from hospitalization that I reported yesterday).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-02
Survey response — day 7, dose 2
MedDRA: Dizziness, Vertigo — Feeling: Poor · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizzy, vertigo whenever I move

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — day 14, dose 2
MedDRA: Balance disorder, Disturbance in attention, Mental disorder, Visual impairment — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: My mental and vision focuses are not normal yet. My balance is not perfect.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Survey response — day 21, dose 2
MedDRA: Diplopia, Fatigue, Gait disturbance, Vertigo — Feeling: Fair · Be unable to work, 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: Continue to have vertigo, and at times double vision. Fatigue and unstable with walking.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Report sent to call center — day 21, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-23
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-30
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-06
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-25
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-28
Call successful
Participant prefers to complete VAERS report online
2022-02-23
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-26	Moderna
2	2021-02-23	Moderna

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-28

Systemic reaction (other): Hospitalized on 2/25/2021, 2/26/2021, 2/27/2021, 2/28/2021 for severe dizziness, vertigo, and nausea; Collapsed on 2/25/2021; Severe dizziness and vertigo on 2/24/2021, 2/25/2021, 2/26/2021, 2/27/2021, 2/28/2021; Severe nausea on 2/25/2021; Mild nausea on 2/26/2021; Severe muscle and body aches on 2/24/2021, 2/25/2021, 2/26/2021; Moderate muscle and body aches on 2/27/2021; Severe fatigue or tiredness on 2/24/2021, 2/25/2021, 2/26/2021; Moderate fatigue or tiredness on 2/27/2021; Mild headache on 2/24/2021, 2/25/2021; Severe vomiting on 2/25/2021; Severe double vision on 2/26/2021 (Note: This whole report was dictated by me to be typed by my designee.)

Healthcare visit (other): Collapsed on 2/25/2021 and required EMT transport to Emergency Room and Hospitalized on 2/25/2021 until 2/28/2021 for severe dizziness, vertigo, and nausea.

2021-03-01

Systemic reaction (other): Very dizzy when I move, vertigo, unable to focus vision, unstable walking (have to use walker), foggy brain

Healthcare visit (other): I will have follow-up visits with my physician and the physical therapist this week (follow-up from hospitalization that I reported yesterday).

Release 4 — day 7, dose 2

2021-03-02

Systemic reaction (other): Dizzy, vertigo whenever I move

Release 5 — day 14, dose 2

2021-03-09

Symptoms: My mental and vision focuses are not normal yet. My balance is not perfect.

Release 5 — day 21, dose 2

2021-03-16

Symptoms: Continue to have vertigo, and at times double vision. Fatigue and unstable with walking.

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	Dizziness	✓	✓	✓
HCVO	Hospitalisation	✓	✓	✓
HCVO	Nausea	✓	✓	✓
HCVO	Vertigo	✓	✓	✓
SD	Balance disorder	✓	✓	✓
SD	Diplopia	✓	✓	✓
SD	Disturbance in attention	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Gait disturbance	✓	✓	✓
SD	Mental disorder	✓	✓	○
SD	Vertigo	✓	✓	✓
SD	Visual impairment	✓	✓	✓
SRO	Diplopia	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Vertigo	✓	✓	✓
SRO	Vision blurred	✓	✓	✓
SRO	Vomiting	✓	✓	✓
SRO	Walking aid user	✓	✓	✓

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