XUC-19095-89121

2 vaccinations 11 coded responses 23 check-ins 11 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 724 / AR
Registered: 2021-02-13

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

2021-02-13
Registered in v-safe
2021-02-13
Dose 1 — Moderna
2021-02-13
Survey response — 0 day, dose 1
MedDRA: Blood glucose increased, Diabetes mellitus, Pre-existing disease — Feeling: Good · Site: Itching · Muscle or body aches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-14
Survey response — days 1–6 daily, dose 1
MedDRA: Nervousness, Tremor — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Nausea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-02-16
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Pain in extremity — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-20
Health check-in — 7 day, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-27
Health check-in — 14 day, dose 1
Feeling: Good

Adult check-in
2021-03-07
Survey response — 21 day, dose 1
MedDRA: Hypertension — Feeling: Fair

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-13
Dose 2 — Moderna
2021-03-14
Survey response — days 1–6 daily, dose 2
MedDRA: Diabetes mellitus, Pre-existing disease — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches

Adult check-in
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — 7 day, dose 2
Feeling: Good · Muscle or body aches, Abdominal pain

Adult check-in
2021-03-28
Survey response — 14 day, dose 2
MedDRA: Arthralgia, Myalgia — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-03
Health check-in — 21 day, dose 2
Feeling: Good

Adult check-in
2021-04-10
Survey response — 28 day, dose 2
MedDRA: Arthralgia — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-17
Survey response — 35 day, dose 2
MedDRA: Arthralgia — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-24
Health check-in — 42 day, dose 2
Feeling: Good

Adult check-in
2021-06-12
Survey response — 3 month, dose 2
MedDRA: Brain fog, Fatigue — Feeling: Good

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-09-11
Health check-in — 6 month, dose 2
Feeling: Good

Adult check-in
2022-03-13
Survey response — 12 month, dose 2
MedDRA: Arthralgia, Chronic kidney disease, Dizziness, Headache, Nausea, Office visit, Skin ulcer — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11 · check-in answers available
2022-03-13
Report sent to call center — 12 month, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-03-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-13	Moderna
2	2021-03-13	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2022-03-13	Successful 2022-03-16	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 4

Systemic reaction (other): I'm diabetic before vaccine my blood glucose was 86, within an hour it rose to 296 had eaten at 05:00, nothing to eat before I checked I was feelin shaky

Systemic reaction (other): Nervousness shaking

Systemic reaction (other): Pain from elbos to hands, knees

Release 5

Symptoms: Uncontrolable high bp, and sudden rise in bg. After a 21 days and a change in some of the bp meds bp starting to come down, and bg getting better just in time for 2nd vaccination on 3/14

Systemic reaction (other): I am diabetic, bg went high after injection, both times. Over 250

Systemic reaction (other): No but before the 2nd shot I injected 5 units of insulin. No problem with high bg after.

Release 6

Symptoms: Joint pain and muscle pain

Release 7

Symptoms: Joint pain, hands, fingers, wrists, elbows, hips.

Symptoms: Hands joints & wrists hurt, this is crazy

Release 9

Symptoms: Tired a lot, some brain fog

Release 11

Symptoms: Joints hurt, shoulders, elbows wrists, fingers, neck, knees. Unexplained sores on legs, arms and torso. DIZZY SPELLS, like never before, headachs, I've never had headachs. Foods that I always liked make me sick to my stomach. Stage 3 CKD!!

Healthcare visit (other): Office vits

Free-text releases are not linked to a specific 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	Brain fog	✓	✓	✓
SD	Chronic kidney disease	·	·	✓
SD	Dizziness	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Hypertension	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Nausea	·	·	✓
SD	Skin ulcer	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Blood glucose increased	✓	✓	✓
SRO	Diabetes mellitus	✓	✓	✓
SRO	Nervousness	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Tremor	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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