5XW-36722-56689

3 vaccinations 7 coded responses 33 check-ins 7 free-text entries 2 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 210 / MD
Registered: 2021-04-07

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

2021-04-07
Registered in v-safe
2021-04-07
Dose 1 — Moderna
2021-04-07
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-10
Survey response — days 1–6 daily, dose 1
MedDRA: Adverse reaction, Rheumatoid arthritis — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: These symptoms are the result of the Methotrexate injection I take weekly for rheumatoid arthritis.

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

Free text: Fatigue is from weekly methotrexate injection taken Fri nights for rheumatoid arthritis.

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

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-14
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-21
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-30
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-05
Dose 2 — Moderna
2021-05-05
Health check-in — day 0, dose 2
Feeling: Fair · Site: Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Joint pains, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-07
Survey response — days 1–6 daily, dose 2
MedDRA: Angioedema, Drug hypersensitivity, Emergency care, Obstructive airways disorder, Uvulitis — Feeling: Poor · Site: Swelling, Itching · 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

Free text: Systemic reaction (other): Suffered sever uvulitis that sent me to the emergency room due to obstruction of my air way, suspect an angioedemic reaction to Lisinopril, which Ive taken for many years without issue; suspected reaction from 2nd Moderna dose; occurred 36 hrs after 2nd dose and within 30 min of a 2.5 mg Lisinopril dose · Healthcare visit (other): Suffered sever uvulitis that sent me to the emergency room due to obstruction of my air way, suspect an angioedemic reaction to Lisinopril, which Ive taken for many years without issue; suspected reaction from 2nd Moderna dose; occurred 36 hrs after 2nd dose and within 30 min of a 2.5 mg Lisinopril dose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
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)
2021-05-08
Survey response — days 1–6 daily, dose 2
MedDRA: Uvulitis — Feeling: Fair · Site: Swelling, Itching · Be unable to work, Be unable to do your normal daily activities

Free text: Continued uvulitis, but under control

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Itching · Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-10
Survey response — days 1–6 daily, dose 2
MedDRA: Uvulitis — Feeling: Fair · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Secondary uvulitis continues to improve

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-12
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-05-19
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-26
Survey response — day 21, dose 2
MedDRA: Hypersensitivity, Pruritus, Rash — Feeling: Fair

Free text: Continued allergic reactions resulting in rashes and itching on arms, neck, face, hands, and lower legs.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-09
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-18
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-04
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-11-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-01-07
Call 1 — Left Voicemail
2022-04-14
Dose 3 — Moderna
2022-05-02
Survey response — day 14, dose 3
MedDRA: Back pain, Condition aggravated, Fatigue, Pre-existing disease, SARS-CoV-2 test positive — 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

Free text: Fatigue, lower back pain. Exacerbation of rheumatoid arthritis symptoms NOTE: cannot select date of positive COVID-19 home test of 2021-12-26. For some reason the date field is weirdly restricted to between 2022-03-22 and 2022-05-02.

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Report sent to call center — day 14, 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-05-03
Call 1 — Left Voicemail
2022-05-03
Call successful
Participant prefers to complete VAERS report online
2022-05-05
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-05-12
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-05-20
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-05-26
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-07-16
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-10-13
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2023-04-14
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-07	Moderna
2	2021-05-05	Moderna
3	2022-04-14	Moderna	No

Call center

2 call center cases

2 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-10

Systemic reaction (other): These symptoms are the result of the Methotrexate injection I take weekly for rheumatoid arthritis.

2021-04-11

Systemic reaction (other): Fatigue is from weekly methotrexate injection taken Fri nights for rheumatoid arthritis.

Release 8 — days 1–6 daily, dose 2

2021-05-07

Systemic reaction (other): Suffered sever uvulitis that sent me to the emergency room due to obstruction of my air way, suspect an angioedemic reaction to Lisinopril, which Ive taken for many years without issue; suspected reaction from 2nd Moderna dose; occurred 36 hrs after 2nd dose and within 30 min of a 2.5 mg Lisinopril dose

Healthcare visit (other): Suffered sever uvulitis that sent me to the emergency room due to obstruction of my air way, suspect an angioedemic reaction to Lisinopril, which Ive taken for many years without issue; suspected reaction from 2nd Moderna dose; occurred 36 hrs after 2nd dose and within 30 min of a 2.5 mg Lisinopril dose

2021-05-08

Systemic reaction (other): Continued uvulitis, but under control

2021-05-10

Systemic reaction (other): Secondary uvulitis continues to improve

Release 8 — day 21, dose 2

2021-05-26

Symptoms: Continued allergic reactions resulting in rashes and itching on arms, neck, face, hands, and lower legs.

Release 11 — day 14, dose 3

2022-05-02

Symptoms: Fatigue, lower back pain. Exacerbation of rheumatoid arthritis symptoms NOTE: cannot select date of positive COVID-19 home test of 2021-12-26. For some reason the date field is weirdly restricted to between 2022-03-22 and 2022-05-02.

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	Angioedema	✓	✓	✓
HCVO	Drug hypersensitivity	✓	✓	✓
HCVO	Emergency care	✓	✓	✓
HCVO	Obstructive airways disorder	✓	✓	✓
HCVO	Uvulitis	✓	✓	✓
SD	Back pain	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Fatigue	·	·	✓
SD	Hypersensitivity	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	SARS-CoV-2 test positive	·	·	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Angioedema	✓	✓	✓
SRO	Drug hypersensitivity	✓	✓	✓
SRO	Emergency care	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Obstructive airways disorder	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rheumatoid arthritis	✓	✓	✓
SRO	Uvulitis	✓	✓	✓

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