63U-33669-27691

3 vaccinations 8 coded responses 14 check-ins 8 free-text entries 1 call case

Sex: Male
Age at first dose: 36-40
ZIP prefix: 714 / LA
Registered: 2021-03-17

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

Timeline

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

2021-03-12
Dose 1 — Moderna
2021-03-17
Registered in v-safe
2021-03-17
Survey response — days 1–6 daily, dose 1
MedDRA: Influenza virus test, Office visit, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test — Feeling: Poor · Fever · Chills, 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 · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Chest Congestion, fever doesnt break. Its been 4 days · Healthcare visit (other): Had Covid test and flu and seen Primary

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Report sent to call center — days 1–6 daily, 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)
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Palpitations, Pyrexia — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to do your normal daily activities

Free text: Racing heart then slows down. Today is day 5 with symptoms and nothing breaks the fever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — day 7, dose 1
MedDRA: Anxiety, Depression, Palpitations — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Racing heart, bad anxiety, some depression

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-09-08
Dose 2 — Moderna
2021-09-09
Dose 3 — Moderna
2021-09-10
Survey response — 6 months, dose 1
MedDRA: Asthenia, Chills, Headache, Injection site pain, Malaise, Night sweats, Pyrexia, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: I had the booster shot. I got really sick. Chills, weak, vomit some, 102 fever I couldnt get to drop below 101 for 18 hours. Night sweats, headache and the jab spot was the sorest out of all the 3. Im ok today but still feel it. Not like 48hr a

MedDRA releases: 2024-11 · check-in free text available
2021-09-13
Survey response — days 1–6 daily, dose 3
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Id like to be able to report correctly and this check isnt coming in on the days it should You cant wait a week to check someone

MedDRA releases: 2024-11 · check-in free text available
2021-09-15
Survey response — days 1–6 daily, dose 3
MedDRA: Adverse reaction — Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Have had these symptoms since booster on 9/8/2021

MedDRA releases: 2024-11 · check-in free text available
2021-09-16
Health check-in — day 7, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-09-23
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-09-30
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-10-07
Survey response — day 28, dose 3
MedDRA: Anxiety, Fatigue, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities

Free text: Fatigue bad. Anxiety is worse. That's all.

MedDRA releases: 2024-11 · check-in free text available
2021-10-14
Survey response — day 35, dose 3
MedDRA: Malaise, Pyrexia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Why does it matter anymore. My whole shots are off on this app and no one has contacted me to fix this issue or speak about how sick I got compared to others and fever never broke. This vsafe is a joke

MedDRA releases: 2024-11 · check-in free text available
2021-10-21
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-02
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-12	Moderna
2	2021-09-08	Moderna	No
3	2021-09-09	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-17

Systemic reaction (other): Chest Congestion, fever doesnt break. Its been 4 days

Healthcare visit (other): Had Covid test and flu and seen Primary

2021-03-18

Systemic reaction (other): Racing heart then slows down. Today is day 5 with symptoms and nothing breaks the fever

Release 5 — day 7, dose 1

2021-03-19

Systemic reaction (other): Racing heart, bad anxiety, some depression

Release 9 — 6 months, dose 1

2021-09-10

Symptoms: I had the booster shot. I got really sick. Chills, weak, vomit some, 102 fever I couldnt get to drop below 101 for 18 hours. Night sweats, headache and the jab spot was the sorest out of all the 3. Im ok today but still feel it. Not like 48hr a

Release 9 — days 1–6 daily, dose 3

2021-09-13

Systemic reaction (other): Id like to be able to report correctly and this check isnt coming in on the days it should You cant wait a week to check someone

2021-09-15

Systemic reaction (other): Have had these symptoms since booster on 9/8/2021

Release 10 — day 28, dose 3

2021-10-07

Symptoms: Fatigue bad. Anxiety is worse. That's all.

Release 10 — day 35, dose 3

2021-10-14

Symptoms: Why does it matter anymore. My whole shots are off on this app and no one has contacted me to fix this issue or speak about how sick I got compared to others and fever never broke. This vsafe is a joke

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	Influenza virus test	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	SARS-CoV-2 test	✓	✓	✓
SD	Anxiety	·	·	✓
SD	Asthenia	·	·	✓
SD	Chills	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Injection site pain	·	·	✓
SD	Malaise	·	·	✓
SD	Night sweats	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Vomiting	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Anxiety	✓	✓	✓
SRO	Depression	✓	✓	✓
SRO	Palpitations	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Unevaluable event	·	·	✓

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