683-15812-03993

3 vaccinations 8 coded responses 41 check-ins 8 free-text entries 3 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 730 / OK
Registered: 2020-12-29

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

Possible VAERS report

VAERS ID	Confidence	Score	Runner-up	Shared symptoms	Dose	State	VAERS vaccinated / onset / received	Call case
1963955 (opens in a new window)	high	9 / 11	-3	1 of 7 VAERS symptoms	same dose (3)	OK matches	2021-12-02 / 2021-12-11 / 2021-12-20 received 8 days before the last call	case 1237759

From the VAERS matching of call center cases (loader/vaers_match_*). Only the best match is shown, and only if it scores 8 or more out of 11. The score adds up timing (VAERS received soon after the call center contact), dose and shared symptoms; state only breaks ties. Confidence is high when the score is 8+ and at least 3 points ahead of the runner-up, medium when 5+ and 2 ahead, otherwise low. A match is a likely link, not a confirmed one.

Timeline

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

2020-12-29
Registered in v-safe
2020-12-29
Dose 1 — Moderna
2020-12-29
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2020-12-30
Survey response — days 1–6 daily, dose 1
MedDRA: Dysuria — Feeling: Good · Site: Pain

Free text: Difficult to urinate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-05
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-12
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-26
Dose 2 — Moderna
2021-01-26
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Diarrhea

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-29
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain

Free text: Painful enlarged lymph nodes left axilla

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Survey response — days 1–6 daily, dose 2
MedDRA: Axillary pain, Lymphadenopathy — Feeling: Good · Site: Pain

Free text: Some mild pain and swelling of lymph nodes in arm pit of shot arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Survey response — days 1–6 daily, dose 2
MedDRA: Axillary pain — Feeling: Good

Free text: Mild pain in axilla of arm where I received the vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-02
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-02
Survey response — day 35, dose 2
MedDRA: Reflux gastritis — Feeling: Good

Free text: Severe episode of gastroesophageal reflux Feb 28

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-27
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-27
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-02
Dose 3 — Moderna
2021-12-02
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-12-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-12-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-05
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness, Diarrhea

Adult check-in
2021-12-09
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-16
Survey response — day 14, dose 3
MedDRA: Cardiac stress test abnormal, Oedema peripheral — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Pitting edema left leg more than right leg and abnormal cardiac stress test

MedDRA releases: 2024-11 · check-in free text available
2021-12-16
Report sent to call center — day 14, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-20
Call successful
Completed over the phone
2021-12-23
Survey response — day 21, dose 3
MedDRA: Cardiac stress test abnormal, Deep vein thrombosis, Office visit, Rotator cuff syndrome, Ultrasound Doppler abnormal — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: DVT in left leg, popliteal vein confirmed on venous Doppler ultrasound. Abnormal nuclear exercise stress test. I had no such problems at all prior to 1 week to 10 days after Moderna booster. Had severe tendinitis in opposite shoulder. · Healthcare visit (other): Cardiologist

MedDRA releases: 2024-11 · check-in free text available
2021-12-23
Report sent to call center — day 21, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-27
Call 1 — Left Voicemail
2021-12-28
Call successful
Reported to VAERS during previous contact from GDIT
2021-12-30
Survey response — day 28, dose 3
MedDRA: Deep vein thrombosis, Oedema peripheral, Office visit, Rotator cuff syndrome — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: DVT left leg. Severe tendinitis left shoulder, pitting edema both legs. · Healthcare visit (other): Diagnostic ultrasound, cardiac ultrasound, nuclear treadmill, bloodwork. Visit w cardiologit. Appointment w a hematogist

MedDRA releases: 2024-11 · check-in free text available
2021-12-30
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-07
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-11
Call 1 — Left Voicemail
2022-01-13
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-14
Call 2 — Left Voicemail
2022-03-03
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-02
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-12-04
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-29	Moderna
2	2021-01-26	Moderna
3	2021-12-02	Moderna	No

Call center

3 call center cases

2 successful · 1 unsuccessful

VAERS report filed, before or during a call: 2

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2020-12-30

Systemic reaction (other): Difficult to urinate

Release 3 — days 1–6 daily, dose 2

2021-01-29

Systemic reaction (other): Painful enlarged lymph nodes left axilla

2021-01-30

Systemic reaction (other): Some mild pain and swelling of lymph nodes in arm pit of shot arm

2021-01-31

Systemic reaction (other): Mild pain in axilla of arm where I received the vaccine

Release 4 — day 35, dose 2

2021-03-02

Symptoms: Severe episode of gastroesophageal reflux Feb 28

Release 10 — day 14, dose 3

2021-12-16

Symptoms: Pitting edema left leg more than right leg and abnormal cardiac stress test

Release 10 — day 21, dose 3

2021-12-23

Symptoms: DVT in left leg, popliteal vein confirmed on venous Doppler ultrasound. Abnormal nuclear exercise stress test. I had no such problems at all prior to 1 week to 10 days after Moderna booster. Had severe tendinitis in opposite shoulder.

Healthcare visit (other): Cardiologist

Release 10 — day 28, dose 3

2021-12-30

Symptoms: DVT left leg. Severe tendinitis left shoulder, pitting edema both legs.

Healthcare visit (other): Diagnostic ultrasound, cardiac ultrasound, nuclear treadmill, bloodwork. Visit w cardiologit. Appointment w a hematogist

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	Office visit	·	·	✓
SD	Cardiac stress test abnormal	·	·	✓
SD	Deep vein thrombosis	·	·	✓
SD	Oedema peripheral	·	·	✓
SD	Reflux gastritis	✓	✓	✓
SD	Rotator cuff syndrome	·	·	✓
SD	Ultrasound Doppler abnormal	·	·	✓
SRO	Axillary pain	✓	✓	✓
SRO	Dysuria	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓

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