8P9-14583-75521

4 vaccinations 9 coded responses 26 check-ins 9 free-text entries 1 call case

Sex: Male
Age at first dose: 46-50
ZIP prefix: 973 / OR
Registered: 2021-11-10

Relationship: Self
Race: N/A
Ethnicity: Not Hispanic or Latino

Registered dependents

39C-13480-04607 Child or adolescent in my care · Female · 2021-11-18

V3A-64440-26422 Child or adolescent in my care · Male · 2021-11-19

Timeline

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

2021-03-10
Dose 1 — Moderna
2021-04-07
Dose 2 — Moderna
2021-11-10
Registered in v-safe
2021-11-10
Dose 3 — Moderna
2021-11-10
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-11-11
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness — Feeling: Poor · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Short waves of dizziness

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Oedema peripheral — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Pain/swelling in armpit on injection side

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness · None

Adult check-in
2021-11-14
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good · Site: Pain, Redness · Fatigue or tiredness

Free text: Mild pain/swelling in lymph node right armpit

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-11-16
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Headache, Fatigue or tiredness

Adult check-in
2021-11-17
Health check-in — day 7, dose 3
Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-24
Survey response — day 14, dose 3
MedDRA: Headache, Productive cough, Sneezing, Upper-airway cough syndrome — Feeling: Good

Free text: Coughing up phlegm in the morning, sneezing, post nasal drip, headaches. Possible new viral symptoms not caused by the vaccine. Mild symptoms. Others in the household have mild symptoms as well.

MedDRA releases: 2024-11 · check-in free text available
2021-12-01
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-15
Survey response — day 35, dose 3
MedDRA: Dizziness, Fatigue, Oropharyngeal pain, Pain, Respiratory tract congestion — Feeling: Poor · Be unable to do your normal daily activities

Free text: Sore throat, tiredness, body aches, some congestion, dizziness.

MedDRA releases: 2024-11 · check-in free text available
2021-12-22
Survey response — day 42, dose 3
MedDRA: Cough, Dizziness, Headache, Nasal congestion, Nasopharyngitis, Oropharyngeal pain, Rhinorrhoea, Viral infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: New cold/viral symptoms (sore throat, coughing, runny stuffy nose, headaches, dizziness)

MedDRA releases: 2024-11 · check-in free text available
2022-02-10
Survey response — 3 months, dose 3
MedDRA: Abdominal pain, Flank pain — Feeling: Fair · 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: Abdominal pain, pain in right side

MedDRA releases: 2024-11 · check-in free text available
2022-02-10
Report sent to call center — 3 months, 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)
2022-02-15
Call successful
Does not wish to fill out VAERS report
2022-05-11
Survey response — 6 months, dose 3
MedDRA: Nasopharyngitis, Viral infection — Feeling: Good · Be unable to do your normal daily activities

Free text: Colds and/or viral infections

MedDRA releases: 2024-11 · check-in free text available
2022-09-07
Dose 4 — Moderna
2022-09-09
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-10
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-11
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-12
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-14
Health check-in — day 7, dose 4
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-21
Survey response — day 14, dose 4
MedDRA: Viral infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: New viral symptoms, not related to the vaccine.

MedDRA releases: 2024-11 · check-in free text available
2022-09-28
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-10-07
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-10-12
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-10-20
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-12-07
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-10	Moderna	No
2	2021-04-07	Moderna	No
3	2021-11-10	Moderna	No
4	2022-09-07	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 10 — days 1–6 daily, dose 3

2021-11-11

Systemic reaction (other): Short waves of dizziness

2021-11-12

Systemic reaction (other): Pain/swelling in armpit on injection side

2021-11-14

Systemic reaction (other): Mild pain/swelling in lymph node right armpit

Release 10 — day 14, dose 3

2021-11-24

Symptoms: Coughing up phlegm in the morning, sneezing, post nasal drip, headaches. Possible new viral symptoms not caused by the vaccine. Mild symptoms. Others in the household have mild symptoms as well.

Release 10 — day 35, dose 3

2021-12-15

Symptoms: Sore throat, tiredness, body aches, some congestion, dizziness.

Release 10 — day 42, dose 3

2021-12-22

Symptoms: New cold/viral symptoms (sore throat, coughing, runny stuffy nose, headaches, dizziness)

Release 11 — 3 months, dose 3

2022-02-10

Symptoms: Abdominal pain, pain in right side

Release 11 — 6 months, dose 3

2022-05-11

Symptoms: Colds and/or viral infections

Release 12 — day 14, dose 4

2022-09-21

Symptoms: New viral symptoms, not related to the vaccine.

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	Cough	·	·	✓
SD	Dizziness	·	·	✓
SD	Fatigue	·	·	✓
SD	Flank pain	·	·	✓
SD	Headache	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Productive cough	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Sneezing	·	·	✓
SD	Upper-airway cough syndrome	·	·	✓
SD	Viral infection	·	·	✓
SRO	Axillary pain	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Lymph node pain	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Oedema peripheral	·	·	✓

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