62Z-25110-29661

5 vaccinations 6 coded responses 35 check-ins 5 free-text entries 4 call cases

Sex: Male
Age at first dose: 46-50
ZIP prefix: 024 / MA
Registered: 2020-12-24

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

2020-12-23
Dose 1 — Moderna
2020-12-24
Registered in v-safe
2020-12-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2020-12-25
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2020-12-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Rash, not including the immediate area around the injection site

Adult check-in
2020-12-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Rash, not including the immediate area around the injection site

Adult check-in
2020-12-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2020-12-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2020-12-30
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-20
Survey response — day 28, dose 1
MedDRA: Headache, Stress — Feeling: Fair

Free text: Worsening of chronic headaches yesterday and today but I doubt this is related to the vaccine. More likely stress related.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Dose 2 — Moderna
2021-01-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches · Be unable to work

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-28
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-11
Survey response — day 21, dose 2
MedDRA: Headache — Feeling: Fair

Free text: Headache but this may be a part of my chronic migraines

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-04-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-22
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-17
Dose 3 — Moderna
2022-01-21
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-02-16
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-18
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-06-16
Dose 4 — Moderna
2022-06-21
Survey response — days 1–6 daily, dose 4
MedDRA: Cough — Feeling: Fair

Free text: Cough but likely not from the shot

MedDRA releases: 2024-11 · check-in free text available
2022-06-22
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-06-23
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-06-30
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-07-07
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-07-14
Survey response — day 28, dose 4
MedDRA: Cough, Headache, Rhinorrhoea, SARS-CoV-2 test positive, Sneezing — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: COVID - tested positive by rapid antigen today. Symptoms started yesterday with cough, sneeze, runny nose, slight headache. No fever. Got Paxlovid.

MedDRA releases: 2024-11 · check-in free text available
2022-07-14
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-07-15
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-09-17
Survey response — 3 months, dose 4
MedDRA: COVID-19, Cough, Dizziness, Fatigue, Rhinorrhoea, Sneezing — 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 · Telehealth, virtual health, or email health consultation

Free text: COVID in July 2022. Cough runny nose sneeze fatigue dizziness

MedDRA releases: 2024-11 · check-in free text available
2022-09-17
Report sent to call center — 3 months, dose 4
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)
2022-09-20
Call successful
Participant prefers to complete VAERS report online
2022-10-06
Dose 5 — Moderna
Co-administered: Flu
2022-12-17
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-01-05
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-04-06
Survey response — 6 months, dose 5
MedDRA: Asthma, Pre-existing disease, Viral infection — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-06
Report sent to call center — 6 months, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-07
Call 1 — Could Not Reach Participant
2023-04-12
Call 2 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-23	Moderna
2	2021-01-21	Moderna
3	2021-11-17	Moderna	No
4	2022-06-16	Moderna	No
5	2022-10-06	Moderna	Flu

Call center

4 call center cases

2 successful · 1 unsuccessful · 1 priority 2/3 (triaged and no follow up)

See the call center timeline

Free text

Release 2 — day 28, dose 1

2021-01-20

Symptoms: Worsening of chronic headaches yesterday and today but I doubt this is related to the vaccine. More likely stress related.

Release 4 — day 21, dose 2

2021-02-11

Symptoms: Headache but this may be a part of my chronic migraines

Release 12 — days 1–6 daily, dose 4

2022-06-21

Systemic reaction (other): Cough but likely not from the shot

Release 12 — day 28, dose 4

2022-07-14

Symptoms: COVID - tested positive by rapid antigen today. Symptoms started yesterday with cough, sneeze, runny nose, slight headache. No fever. Got Paxlovid.

Release 12 — 3 months, dose 4

2022-09-17

Symptoms: COVID in July 2022. Cough runny nose sneeze fatigue dizziness

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
SD	Asthma	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Dizziness	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sneezing	·	·	✓
SD	Stress	✓	✓	✓
SD	Viral infection	·	·	✓
SRO	Cough	·	·	✓

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