69D-17411-89263

3 vaccinations 9 coded responses 38 check-ins 9 free-text entries 5 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 926 / CA
Registered: 2021-01-24

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

Timeline

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

2021-01-24
Registered in v-safe
2021-01-24
Dose 1 — Moderna
2021-01-24
Health check-in — day 0, dose 1
Feeling: Good · None

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

Adult check-in
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Wheezing — Feeling: Good

Free text: Repiratory wheezing - perhaps uptick in allergies

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate irregular, Hypotension, Office visit — Feeling: Fair · Diarrhea · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Low BP and irregular heart beat · Healthcare visit (other): Previously Scheduled visit with Doctor at his office - brought up concerns

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-29
Survey response — days 1–6 daily, dose 1
MedDRA: Extrasystoles, Hypotension — Feeling: Good

Free text: Having occaisional extra heartbeats per Cardiaolgist - sometimes low BP

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Diarrhea

Adult check-in
2021-02-07
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-14
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-21
Survey response — day 28, dose 1
MedDRA: Gastrointestinal disorder, Medical counselling — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Still have a digestive issue going on - have consulted with mi GI doc

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Report sent to call center — day 28, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-26
Dose 2 — Moderna
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Fatigue or tiredness

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-28
Survey response — 3 months, dose 2
MedDRA: Migraine — Feeling: Good · 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: Migrane Headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-28
Report sent to call center — 3 months, 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)
2021-06-04
Call successful
Participant prefers to complete VAERS report online
2021-06-04
Call successful
Participant prefers to complete VAERS report online
2021-06-04
Call successful
Participant prefers to complete VAERS report online
2021-08-27
Survey response — 6 months, dose 2
MedDRA: Meniere's disease, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Had an minieres like problem in my right ear - may have been allergy or immune reaction · Healthcare visit (other): Ear Doctor

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-27
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-02
Call 1 — Left Voicemail
2021-10-24
Dose 3 — Moderna
2021-10-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fever · Chills, Fatigue or tiredness

Adult check-in
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: Migraine — Feeling: Fair · Site: Pain · Headache

Free text: Migraine

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-31
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-07
Survey response — day 14, dose 3
MedDRA: Arthralgia, Chest pain — Feeling: Good

Free text: Sore joints in arms and sternum

MedDRA releases: 2024-11 · check-in free text available
2021-11-14
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-21
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-28
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-05
Survey response — day 42, dose 3
MedDRA: Muscle spasms, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: cramping of miscles in left arm · Healthcare visit (other): family doctor visit

MedDRA releases: 2024-11 · check-in free text available
2021-12-05
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-08
Call 1 — Left Voicemail
2022-01-23
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-24
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-24
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-24	Moderna
2	2021-02-26	Moderna
3	2021-10-24	Moderna	No

Call center

5 call center cases

3 successful · 2 unsuccessful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-27

Systemic reaction (other): Repiratory wheezing - perhaps uptick in allergies

2021-01-28

Systemic reaction (other): Low BP and irregular heart beat

Healthcare visit (other): Previously Scheduled visit with Doctor at his office - brought up concerns

Release 3 — days 1–6 daily, dose 1

2021-01-29

Systemic reaction (other): Having occaisional extra heartbeats per Cardiaolgist - sometimes low BP

Release 4 — day 28, dose 1

2021-02-21

Symptoms: Still have a digestive issue going on - have consulted with mi GI doc

Release 8 — 3 months, dose 2

2021-05-28

Symptoms: Migrane Headache

Release 9 — 6 months, dose 2

2021-08-27

Symptoms: Had an minieres like problem in my right ear - may have been allergy or immune reaction

Healthcare visit (other): Ear Doctor

Release 10 — days 1–6 daily, dose 3

2021-10-27

Systemic reaction (other): Migraine

Release 10 — day 14, dose 3

2021-11-07

Symptoms: Sore joints in arms and sternum

Release 10 — day 42, dose 3

2021-12-05

Symptoms: cramping of miscles in left arm

Healthcare visit (other): family doctor visit

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	Arthralgia	·	·	✓
SD	Chest pain	·	·	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Medical counselling	✓	✓	✓
SD	Meniere's disease	✓	·	✓
SD	Migraine	✓	✓	✓
SD	Muscle spasms	·	·	✓
SRO	Extrasystoles	✓	✓	✓
SRO	Heart rate irregular	✓	✓	✓
SRO	Hypotension	✓	✓	✓
SRO	Migraine	·	·	✓
SRO	Wheezing	✓	✓	✓

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