5X2-25096-93047

1 vaccination 9 coded responses 9 check-ins 9 free-text entries 5 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 490 / MI
Registered: 2021-03-30

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

Timeline

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

2021-03-26
Dose 1 — Moderna
2021-03-30
Registered in v-safe
2021-03-30
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Arm felt like big buddy SLUGGED where 2 injection holes are.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Trouble breathing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea, Paranasal sinus hypersecretion — Feeling: Fair · Site: Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Nasty sinus crap, light green. Still trouble breathing deep.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Survey response — day 7, dose 1
MedDRA: Dyspnoea, Sinus congestion — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Little trouble with deep breathing. Serious sinus congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Survey response — day 14, dose 1
MedDRA: Asthenia, Dizziness, Headache, Insomnia, Medical counselling, Pain, Pyrexia, Vision blurred — Feeling: Poor · Be unable to work, 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: Worse but same symptoms as Covid I had 11/15-25/2020. Heavy very sticky mucus, breathing difficulty, fever for 5 days, weakness, aches, difficult sleeping, lightheaded, headaches, blurred vision, and the rest that it'll do. I tested negative CVS · Healthcare visit (other): Dr. (b)(6) daily called to/from, ordered Amoxicillin, tussin, mucus relief, Tylenol, hydrate, try to rest. Keep in touch. Go to ER if worsens. Recommend not getting 2nd shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Report sent to call center — day 14, dose 1
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)
2021-04-17
Survey response — day 21, dose 1
MedDRA: Dyspnoea, Medical counselling, Secretion discharge, Self-medication — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Breathing difficulties with heavy-duty mucus in my lungs and throat. Used mucus relief and tussin with expectorant together for several days to break up several large amounts of discharge. This has helped, but overdose worry stopped further. · Healthcare visit (other): Phone calls for my regular physician. If it didn't work, he said go to the ER.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Report sent to call center — day 21, dose 1
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)
2021-06-27
Survey response — 3 months, dose 1
MedDRA: Dyspnoea, Office visit, Peripheral swelling, Sinus disorder — 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

Free text: Symptoms: Swelling in feet, and difficulty breathing. Severe sinus issues continue. · Healthcare visit (other): July 15th scheduled appointment with primary care physician. He ordered chest x-rays, which I got from (b)(6) Hospital.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-27
Report sent to call center — 3 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-29
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2021-09-25
Survey response — 6 months, dose 1
MedDRA: Blood pressure abnormal, Cardiac disorder, Dyspnoea, Fluid retention, Office visit, Testicular swelling — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Besides the heart issues (I'm getting ekho next week and cardiologist appointment next month) my body has more water retention, blood pressure problems, and breathing, or short of breath. Plus now swollen testes sac. None before like this. · Healthcare visit (other): Made appointments for primary and cardiologist

MedDRA releases: 2024-11 · check-in free text available
2021-09-25
Report sent to call center — 6 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-29
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-03-26
Survey response — 12 months, dose 1
MedDRA: Emergency care, Hospitalisation, Intestinal pseudo-obstruction — Feeling: Fair · 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Diagnosed with Ogilvie syndrome · Healthcare visit (other): 5 Emergency trips, 3 hospital admissions, December 2021, January 2022

MedDRA releases: 2024-11 · check-in free text available
2022-03-26
Report sent to call center — 12 months, dose 1
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 · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-03-28
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-26	Moderna

Call center

5 call center cases

5 successful

VAERS report filed, before or during a call: 4

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-30

Systemic reaction (other): Arm felt like big buddy SLUGGED where 2 injection holes are.

2021-03-31

Systemic reaction (other): Trouble breathing

2021-04-01

Systemic reaction (other): Nasty sinus crap, light green. Still trouble breathing deep.

Release 6 — day 7, dose 1

2021-04-02

Systemic reaction (other): Little trouble with deep breathing. Serious sinus congestion

Release 7 — day 14, dose 1

2021-04-09

Symptoms: Worse but same symptoms as Covid I had 11/15-25/2020. Heavy very sticky mucus, breathing difficulty, fever for 5 days, weakness, aches, difficult sleeping, lightheaded, headaches, blurred vision, and the rest that it'll do. I tested negative CVS

Healthcare visit (other): Dr. (b)(6) daily called to/from, ordered Amoxicillin, tussin, mucus relief, Tylenol, hydrate, try to rest. Keep in touch. Go to ER if worsens. Recommend not getting 2nd shot.

redacted (b)(6)

Release 7 — day 21, dose 1

2021-04-17

Symptoms: Breathing difficulties with heavy-duty mucus in my lungs and throat. Used mucus relief and tussin with expectorant together for several days to break up several large amounts of discharge. This has helped, but overdose worry stopped further.

Healthcare visit (other): Phone calls for my regular physician. If it didn't work, he said go to the ER.

Release 9 — 3 months, dose 1

2021-06-27

Symptoms: Swelling in feet, and difficulty breathing. Severe sinus issues continue.

Healthcare visit (other): July 15th scheduled appointment with primary care physician. He ordered chest x-rays, which I got from (b)(6) Hospital.

redacted (b)(6)

Release 9 — 6 months, dose 1

2021-09-25

Symptoms: Besides the heart issues (I'm getting ekho next week and cardiologist appointment next month) my body has more water retention, blood pressure problems, and breathing, or short of breath. Plus now swollen testes sac. None before like this.

Healthcare visit (other): Made appointments for primary and cardiologist

Release 11 — 12 months, dose 1

2022-03-26

Symptoms: Diagnosed with Ogilvie syndrome

Healthcare visit (other): 5 Emergency trips, 3 hospital admissions, December 2021, January 2022

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	Hospitalisation	·	·	✓
HCVO	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Blood pressure abnormal	·	·	✓
SD	Cardiac disorder	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fluid retention	·	·	✓
SD	Headache	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Intestinal pseudo-obstruction	·	·	✓
SD	Pain	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Secretion discharge	✓	✓	✓
SD	Self-medication	✓	✓	✓
SD	Sinus disorder	✓	✓	✓
SD	Testicular swelling	·	·	✓
SD	Vision blurred	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Paranasal sinus hypersecretion	✓	✓	✓
SRO	Sinus congestion	✓	✓	✓

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