5WZ-30478-97400

2 vaccinations 11 coded responses 13 check-ins 11 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 600 / IL
Registered: 2021-04-03

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

2021-03-03
Dose 1 — Moderna
2021-04-03
Registered in v-safe
2021-04-03
Dose 2 — Moderna
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue, Feeling hot — Feeling: Good

Free text: Yesterday around 9:00 PM was feeding feverish, fatigue and tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspepsia — Feeling: Fair · Site: Itching · Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Heartburn

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspepsia, Throat irritation — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Heartburn in the evening, itchy throat in the evening.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspepsia, Extrasystoles, Pain in extremity — Feeling: Poor · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Heartburn, pain in neck and legs

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

Free text: Ear ache, neck pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Survey response — day 7, dose 2
MedDRA: Ear pain, Pain in extremity — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Pain in leggs, earache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Survey response — day 14, dose 2
MedDRA: Fatigue, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Legs pain, fatigued

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-04
Survey response — day 28, dose 2
MedDRA: Disturbance in attention, Fatigue — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Lack of concentration, fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-08
Survey response — day 35, dose 2
MedDRA: Arthralgia, Back pain, Ear pain — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Backache, pain in wrist, earaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-05
Survey response — 3 months, dose 2
MedDRA: Back pain, Pain in extremity — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Legs and back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-02
Survey response — 6 months, dose 2
MedDRA: Constipation, Gait disturbance, Hospitalisation, Physiotherapy — Feeling: Poor · Be unable to work or attend school, 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: Symptoms: Severe constipation, was hospitalized for a number of days.Problem walking straight, getting physical Therapy for that condition. · Healthcare visit (other): Physical Therapy

MedDRA releases: 2024-11 · check-in free text available
2021-10-02
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

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-10-04
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-03	Moderna
2	2021-04-03	Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 2

2021-04-05

Systemic reaction (other): Yesterday around 9:00 PM was feeding feverish, fatigue and tiredness

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): Heartburn

2021-04-07

Systemic reaction (other): Heartburn in the evening, itchy throat in the evening.

2021-04-08

Systemic reaction (other): Heartburn, pain in neck and legs

2021-04-09

Systemic reaction (other): Ear ache, neck pain

Release 7 — day 7, dose 2

2021-04-10

Systemic reaction (other): Pain in leggs, earache

Release 7 — day 14, dose 2

2021-04-17

Symptoms: Legs pain, fatigued

Release 8 — day 28, dose 2

2021-05-04

Symptoms: Lack of concentration, fatigue

Release 8 — day 35, dose 2

2021-05-08

Symptoms: Backache, pain in wrist, earaches

Release 9 — 3 months, dose 2

2021-07-05

Symptoms: Legs and back pain

Release 9 — 6 months, dose 2

2021-10-02

Symptoms: Severe constipation, was hospitalized for a number of days.Problem walking straight, getting physical Therapy for that condition.

Healthcare visit (other): Physical Therapy

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	Physiotherapy	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Constipation	·	·	✓
SD	Disturbance in attention	✓	✓	✓
SD	Ear pain	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gait disturbance	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Physiotherapy	·	·	✓
SRO	Dyspepsia	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Extrasystoles	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Throat irritation	✓	✓	✓

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