6F4-83424-15818

3 vaccinations 14 coded responses 31 check-ins 14 free-text entries 4 call cases

Sex: Male
Age at first dose: 21-25
ZIP prefix: 088 / NJ
Registered: 2021-01-23

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

2021-01-23
Registered in v-safe
2021-01-23
Dose 1 — Moderna
2021-01-24
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Dyspepsia, Pleuritic pain — Feeling: Good · Site: Pain

Free text: Intermittent Pleuritic chest pain on deep inspiration. Some indigestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspepsia, Pleuritic pain — Feeling: Good

Free text: Pleuritic chest pain on deep inspiration, some indigestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Dyspepsia, Painful respiration — Feeling: Good

Free text: Pleuritic chest pain on deep inspiration, indigestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-06
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: Abdominal pain, Chills, Night sweats, Pyrexia — Feeling: Good · Be unable to do your normal daily activities

Free text: Mild night sweat, chills, low grade fever over 100 F for one night. Beginning Hours prior to that evening- some diffuse intermittent abdominal pain/ache that lasted 2-3 days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Dose 2 — Moderna
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Night sweats — Feeling: Fair · Site: Pain · Headache

Free text: Night sweats (not drenching but clothes damp overnight changed them)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · 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
Survey response — day 7, dose 2
MedDRA: Nerve compression — Feeling: Good

Free text: Pinch sensation of left lateral knee upon walking up stairs occasionally with associated vein enlargement

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — day 14, dose 2
MedDRA: Skin warm, Vascular pain, Vasodilatation — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Lateral superficial leg vein engorgement, warmth, pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-18
Survey response — day 21, dose 2
MedDRA: Blepharospasm, Headache, Pain in extremity — Feeling: Good

Free text: Headache, transient. Eye twitch, transient. Focal arm pain, same arm of injection, sharp at night, 20 min, isolated.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Survey response — day 28, dose 2
MedDRA: Nausea, Pain, Scrotal pain, Scrotal swelling, Varicocele — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Enlargement of vessels in scrotal sack (left). Relieved by laying down. Some associated dull pain and nausea (occasional).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-03
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-29
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Burning sensation, Flank pain, Muscle spasms, Pain in extremity, Rash, Rash erythematous — Feeling: Good

Free text: Intermittent Left flank pain/burning. Left leg cramping and ache. Focal red rashes of left leg and buttocks

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-27
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Haematochezia — Feeling: Good · Be unable to do your normal daily activities

Free text: Knee pain. Hematochezia

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-13
Call successful
Does not wish to fill out VAERS report
2021-11-20
Dose 3 — Moderna
2021-11-20
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-21
Survey response — days 1–6 daily, dose 3
MedDRA: Muscle spasms, Paraesthesia, Pleuritic pain — Feeling: Fair · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Fleeting pleuritic chest pain, foot cramp, leg paresthesia

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Muscle or body aches, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-11-23
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-11-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-11-28
Health check-in — day 7, dose 3
Feeling: Good · Joint pains, Muscle or body aches, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Adult check-in
2021-11-28
Report sent to call center — day 7, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-30
Call 1 — Left Voicemail
2021-12-04
Survey response — day 14, dose 3
MedDRA: Arthralgia, Gastrooesophageal reflux disease — Feeling: Good

Free text: Episode of reflux. Joint pains, fleeting, intermittent, mild.

MedDRA releases: 2024-11 · check-in free text available
2021-12-16
Survey response — day 21, dose 3
MedDRA: Lacrimation increased, Nasal congestion, Pharyngeal erythema, Rhinorrhoea, Upper-airway cough syndrome — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Post nasal drip. Nasal congestion. Watery eyes. Rhinorrhea. Pharynx erythema

MedDRA releases: 2024-11 · check-in free text available
2021-12-16
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)
2021-12-18
Call 1 — Left Voicemail
2021-12-26
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-01
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-23	Moderna
2	2021-02-25	Moderna
3	2021-11-20	Moderna	No

Call center

4 call center cases

2 successful · 2 unsuccessful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-24

Systemic reaction (other): Intermittent Pleuritic chest pain on deep inspiration. Some indigestion

2021-01-25

Systemic reaction (other): Pleuritic chest pain on deep inspiration, some indigestion

2021-01-26

Systemic reaction (other): Pleuritic chest pain on deep inspiration, indigestion

Release 4 — day 28, dose 1

2021-02-21

Symptoms: Mild night sweat, chills, low grade fever over 100 F for one night. Beginning Hours prior to that evening- some diffuse intermittent abdominal pain/ache that lasted 2-3 days.

Release 4 — days 1–6 daily, dose 2

2021-02-28

Systemic reaction (other): Night sweats (not drenching but clothes damp overnight changed them)

Release 5 — day 7, dose 2

2021-03-04

Systemic reaction (other): Pinch sensation of left lateral knee upon walking up stairs occasionally with associated vein enlargement

Release 5 — day 14, dose 2

2021-03-12

Symptoms: Lateral superficial leg vein engorgement, warmth, pain.

Release 5 — day 21, dose 2

2021-03-18

Symptoms: Headache, transient. Eye twitch, transient. Focal arm pain, same arm of injection, sharp at night, 20 min, isolated.

Release 6 — day 28, dose 2

2021-03-27

Symptoms: Enlargement of vessels in scrotal sack (left). Relieved by laying down. Some associated dull pain and nausea (occasional).

Release 8 — 3 months, dose 2

2021-05-29

Symptoms: Intermittent Left flank pain/burning. Left leg cramping and ache. Focal red rashes of left leg and buttocks

Release 9 — 6 months, dose 2

2021-08-27

Symptoms: Knee pain. Hematochezia

Release 10 — days 1–6 daily, dose 3

2021-11-21

Systemic reaction (other): Fleeting pleuritic chest pain, foot cramp, leg paresthesia

Release 10 — day 14, dose 3

2021-12-04

Symptoms: Episode of reflux. Joint pains, fleeting, intermittent, mild.

Release 10 — day 21, dose 3

2021-12-16

Symptoms: Post nasal drip. Nasal congestion. Watery eyes. Rhinorrhea. Pharynx erythema

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	Abdominal pain	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Blepharospasm	✓	✓	✓
SD	Burning sensation	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Flank pain	✓	✓	✓
SD	Gastrooesophageal reflux disease	·	·	✓
SD	Haematochezia	✓	·	✓
SD	Headache	✓	✓	✓
SD	Lacrimation increased	·	·	✓
SD	Muscle spasms	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	Nausea	✓	✓	✓
SD	Night sweats	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pharyngeal erythema	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash erythematous	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	Scrotal pain	✓	·	✓
SD	Scrotal swelling	○	✓	○
SD	Skin warm	✓	✓	✓
SD	Upper-airway cough syndrome	·	·	✓
SD	Varicocele	✓	·	✓
SD	Vascular pain	✓	✓	✓
SD	Vasodilatation	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Dyspepsia	✓	✓	✓
SRO	Muscle spasms	·	·	✓
SRO	Nerve compression	✓	✓	✓
SRO	Night sweats	✓	✓	✓
SRO	Painful respiration	✓	✓	✓
SRO	Paraesthesia	·	·	✓
SRO	Pleuritic pain	✓	✓	✓

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