6PK-89820-05375

5 vaccinations 20 coded responses 64 check-ins 19 free-text entries 9 call cases

Sex: Male
Age at first dose: 16-20
ZIP prefix: 787 / TX
Registered: 2021-03-04

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-03-04
Registered in v-safe
2021-03-04
Dose 1 — Moderna
2021-03-04
Survey response — day 0, dose 1
MedDRA: Fatigue, Hyperhidrosis, Nasal congestion — Feeling: Good · Site: Pain

Free text: Fatigue, sweating and stuffy nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — days 1–6 daily, dose 1
MedDRA: Joint lock, Paraesthesia — Feeling: Fair · Site: Pain, Redness, Swelling · Muscle or body aches · Be unable to do your normal daily activities

Free text: Left arm bycept locked up and tingled. Locked completely for 1 min then released.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-20
Survey response — day 14, dose 1
MedDRA: Gastroenteritis salmonella, Salmonellosis — Feeling: Poor · 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: Salmonella diagnosis.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 14, 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)
2021-03-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-01
Dose 2 — Moderna
2021-04-01
Survey response — day 0, dose 2
MedDRA: Muscle twitching — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: For arm muscles twitching a lot in both for arms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Muscle twitching — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Nerve twitching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — days 1–6 daily, dose 2
MedDRA: Medical counselling, Muscle twitching — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Continued nerve twitching in for arms · Healthcare visit (other): Phone call to doctor for advice

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Report sent to call center — days 1–6 daily, 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)
2021-04-04
Survey response — days 1–6 daily, dose 2
MedDRA: Photopsia — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Seeing stars

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Medical counselling, Muscle twitching — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, 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 · Hospitalization

Free text: Systemic reaction (other): Periodic arm twitching · Healthcare visit (other): Phone call

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Report sent to call center — days 1–6 daily, 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)
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-04-10
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-13
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-15
Call 1 — Requested Callback
2021-06-15
Call 1 — Requested Callback
2021-06-15
Call 1 — Requested Callback
2021-06-16
Callback requested for
12:00PM CT
2021-06-16
Callback requested for
12:00PM CT
2021-06-16
Call 2 — Left Voicemail
2021-06-16
Callback requested for
12:00PM CT
2021-07-01
Survey response — 3 months, dose 2
MedDRA: Office visit, Social anxiety disorder — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Developed a bit of anxiety (social). Prescribed medication for this. · Healthcare visit (other): Psychologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-01
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-06
Call 1 — Left Voicemail
2021-09-30
Survey response — 6 months, dose 2
MedDRA: Pain, Respiratory tract congestion — Feeling: Poor · Be unable to work or attend school, 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: Chest congestion and body aches.

MedDRA releases: 2024-11 · check-in free text available
2021-09-30
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-04
Call successful
Participant prefers to complete VAERS report online
2021-10-04
Call successful
Participant prefers to complete VAERS report online
2021-10-04
Call successful
Participant prefers to complete VAERS report online
2021-10-04
Call successful
Participant prefers to complete VAERS report online
2021-10-04
Call successful
Participant prefers to complete VAERS report online
2021-11-30
Dose 3 — Moderna
Co-administered: Flu
2021-11-30
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2021-12-01
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, 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
2021-12-02
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Joint pains, Muscle or body aches · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-12-03
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-12-05
Survey response — days 1–6 daily, dose 3
MedDRA: Emergency care — Feeling: Poor · Site: Pain · Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional

Free text: Ems

MedDRA releases: 2024-11 · check-in free text available
2021-12-05
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-07
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-07
Call 2 — Left Voicemail
2021-12-14
Survey response — day 14, dose 3
MedDRA: Rash — Feeling: Fair

Free text: Rash all over my body

MedDRA releases: 2024-11 · check-in free text available
2021-12-21
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-28
Survey response — day 28, dose 3
MedDRA: Office visit, Urticaria — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Hives but I don't think it's from the COVID shot. · Healthcare visit (other): PCP visit then referral to allergist. NOT DUE TO COVID-19 SHOT

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

1 call case(s)
2021-12-30
Call 2 — Could Not Reach Participant
2022-01-04
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-11
Survey response — day 42, dose 3
MedDRA: Pruritus, Unevaluable event, Urticaria — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Hives all over my body extreme itching · Healthcare visit (other): Allergy testing

MedDRA releases: 2024-11 · check-in free text available
2022-01-11
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-01-12
Call 1 — Left Voicemail
2022-03-01
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
2022-06-30
Dose 4 — Moderna
2022-07-01
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, 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
2022-07-02
Survey response — days 1–6 daily, dose 4
MedDRA: Lymphadenitis — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Enflaimed lymph nodes under armpits. Happened after my two other COVID shots (original doses and previous booster)

MedDRA releases: 2024-11 · check-in free text available
2022-07-03
Survey response — days 1–6 daily, dose 4
MedDRA: Exposure to SARS-CoV-2 — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Free text: Exposed to confirmed COVID-19 case yesterday 7/2/2022

MedDRA releases: 2024-11 · check-in free text available
2022-07-04
Survey response — days 1–6 daily, dose 4
MedDRA: Exposure to SARS-CoV-2, Quarantine — Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Exposed to COVID confirmed case- quarantining for 48 hrs.

MedDRA releases: 2024-11 · check-in free text available
2022-07-05
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-07-06
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-07-07
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-07-16
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-07-21
Survey response — day 21, dose 4
MedDRA: Poisoning, Sunburn — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Sun poisoning from a bad sum burn

MedDRA releases: 2024-11 · check-in free text available
2022-07-28
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-08-04
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-08-11
Survey response — day 42, dose 4
MedDRA: Migraine, Rash — Feeling: Fair

Free text: Migraine today and rash on my hand's over the past 2-3 days.

MedDRA releases: 2024-11 · check-in free text available
2022-09-29
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-12-29
Dose 5 — Moderna
2022-12-31
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2022-12-31
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Redness, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2023-01-01
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2023-01-03
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2023-01-04
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Fatigue or tiredness

Adult check-in
2023-01-05
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2023-01-12
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2023-01-21
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2023-01-26
Survey response — day 28, dose 5
MedDRA: Office visit, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-01-26
Report sent to call center — day 28, dose 5
Get care from a doctor or other healthcare professional

1 call case(s)
2023-01-27
Call 1 — Left Voicemail
2023-01-27
Call 1 — Left Voicemail
2023-01-27
Call 2 — Left Voicemail
2023-01-27
Call 1 — Left Voicemail
2023-02-02
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2023-02-11
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-03-30
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-06-29
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-04	Moderna
2	2021-04-01	Moderna
3	2021-11-30	Moderna	Flu
4	2022-06-30	Moderna	No
5	2022-12-29	Moderna	No

Call center

9 call center cases

5 successful · 4 unsuccessful

See the call center timeline

Free text

Release 5 — day 0, dose 1

2021-03-04

Systemic reaction (other): Fatigue, sweating and stuffy nose

Release 5 — days 1–6 daily, dose 1

2021-03-05

Systemic reaction (other): Left arm bycept locked up and tingled. Locked completely for 1 min then released.

Release 6 — day 14, dose 1

2021-03-20

Symptoms: Salmonella diagnosis.

Release 6 — day 0, dose 2

2021-04-01

Systemic reaction (other): For arm muscles twitching a lot in both for arms

Release 6 — days 1–6 daily, dose 2

2021-04-02

Systemic reaction (other): Nerve twitching

2021-04-03

Systemic reaction (other): Continued nerve twitching in for arms

Healthcare visit (other): Phone call to doctor for advice

2021-04-04

Systemic reaction (other): Seeing stars

Release 7 — days 1–6 daily, dose 2

2021-04-05

Systemic reaction (other): Periodic arm twitching

Healthcare visit (other): Phone call

Release 9 — 3 months, dose 2

2021-07-01

Symptoms: Developed a bit of anxiety (social). Prescribed medication for this.

Healthcare visit (other): Psychologist

Release 9 — 6 months, dose 2

2021-09-30

Symptoms: Chest congestion and body aches.

Release 10 — days 1–6 daily, dose 3

2021-12-05

Healthcare visit (other): Ems

Release 10 — day 14, dose 3

2021-12-14

Symptoms: Rash all over my body

Release 10 — day 28, dose 3

2021-12-28

Symptoms: Hives but I don't think it's from the COVID shot.

Healthcare visit (other): PCP visit then referral to allergist. NOT DUE TO COVID-19 SHOT

Release 10 — day 42, dose 3

2022-01-11

Symptoms: Hives all over my body extreme itching

Healthcare visit (other): Allergy testing

Release 12 — days 1–6 daily, dose 4

2022-07-02

Systemic reaction (other): Enflaimed lymph nodes under armpits. Happened after my two other COVID shots (original doses and previous booster)

2022-07-03

Systemic reaction (other): Exposed to confirmed COVID-19 case yesterday 7/2/2022

2022-07-04

Systemic reaction (other): Exposed to COVID confirmed case- quarantining for 48 hrs.

Release 12 — day 21, dose 4

2022-07-21

Symptoms: Sun poisoning from a bad sum burn

Release 12 — day 42, dose 4

2022-08-11

Symptoms: Migraine today and rash on my hand's over the past 2-3 days.

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	Emergency care	·	·	✓
HCVO	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Unevaluable event	·	·	✓
SD	Gastroenteritis salmonella	○	✓	○
SD	Migraine	·	·	✓
SD	Pain	·	·	✓
SD	Poisoning	·	·	✓
SD	Pruritus	·	·	✓
SD	Rash	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Salmonellosis	✓	·	✓
SD	Social anxiety disorder	✓	✓	✓
SD	Sunburn	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Urticaria	·	·	✓
SRO	Exposure to SARS-CoV-2	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Joint lock	✓	✓	✓
SRO	Lymphadenitis	·	·	✓
SRO	Muscle twitching	✓	✓	✓
SRO	Nasal congestion	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Photopsia	✓	✓	✓
SRO	Quarantine	·	·	✓

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