XYD-12847-60777

2 vaccinations 13 coded responses 23 check-ins 13 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 230 / VA
Registered: 2021-01-20

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

2021-01-19
Dose 1 — Moderna
2021-01-20
Registered in v-safe
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-25
Survey response — days 1–6 daily, dose 1
MedDRA: Rhinorrhoea, Sneezing — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-01-26
Health check-in — 7 day, dose 1
Feeling: Good · None

Adult check-in
2021-02-02
Survey response — 14 day, dose 1
MedDRA: Rhinorrhoea, Vision blurred — Feeling: Fair

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-09
Survey response — 21 day, dose 1
MedDRA: Fatigue, Productive cough, Sinus disorder, Throat clearing — Feeling: Fair

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-16
Health check-in — 28 day, dose 1
Feeling: Fair

Adult check-in
2021-02-23
Health check-in — 35 day, dose 1
Feeling: Fair

Adult check-in
2021-02-24
Dose 2 — Moderna
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Productive cough, Rhinorrhoea — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: Productive cough, Rhinorrhoea — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-27
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Insomnia, Lethargy — Feeling: Poor · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Chills, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-03-03
Survey response — 7 day, dose 2
MedDRA: Dizziness — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-10
Survey response — 14 day, dose 2
MedDRA: Abdominal discomfort, Dizziness — Feeling: Poor · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-17
Health check-in — 21 day, dose 2
Feeling: Fair

Adult check-in
2021-03-24
Health check-in — 28 day, dose 2
Feeling: Fair

Adult check-in
2021-03-31
Survey response — 35 day, dose 2
MedDRA: Arthralgia, Dizziness, Fatigue, Nausea — Feeling: Poor · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-07
Health check-in — 42 day, dose 2
Feeling: Fair

Adult check-in
2021-05-26
Survey response — 3 month, dose 2
MedDRA: Cough, Dizziness, Dyspnoea, Fatigue, Headache, Insomnia, Muscular weakness, Productive cough — Feeling: Poor · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-08-25
Survey response — 6 month, dose 2
MedDRA: Asthenia, Atrial hypertrophy, Dizziness, Mitral valve repair, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-25
Report sent to call center — 6 month, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-07
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-02-24
Survey response — 12 month, dose 2
MedDRA: Condition aggravated, Monoplegia, Office visit, Pre-existing disease — 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, Emergency room or emergency department visit

MedDRA releases: 2024-11 · check-in answers available
2022-02-24
Report sent to call center — 12 month, 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 · Emergency room or emergency department visit · 1 call case(s)
2022-02-25
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-19	Moderna
2	2021-02-24	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-08-25	Successful 2021-10-07	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-02-24	Unsuccessful

Free text

Release 2

Systemic reaction (other): Sniffles, sneezing, runny nose

Release 3

Symptoms: Runny nose, slightly blurred vision,farigue

Symptoms: Increased sinus problem,fatigue increase,increase phlegm requiring me to clear throat .

Release 4

Systemic reaction (other): Excessive sniffles and phlegm. Lightedness

Systemic reaction (other): Sniffles remain , excess phlegm

Systemic reaction (other): Extreme dizziness. And lethargy. Was not able to sleep very well.

Systemic reaction (other): Still a bit lightheaded and dizzy

Release 5

Systemic reaction (other): Light headedness

Symptoms: Dizziness,lightheaded ness ,upset stomach

Release 6

Symptoms: Dizziness,lightheaded ness, fatigue, joint aches, nausea

Release 8

Symptoms: Excess fatigue,lighted ness,headache,weakness in legs,difficulty breathing,excess phlegm and coughing. Insomnia.

Release 9

Symptoms: Had to have a Transcatheter mitral valve in valve procedure on July 22,2021. Recovery is slow due to right atrial hypertrophy due to duration of the stenosed prosthetic mitral valve before it was detected. Iam very light headed and weak as a result cut off by CDC

Release 11

Symptoms: Worsening of lumbar stenosis,pain severe. Partial paralysis of right arm.

Healthcare visit (other): Dr visits

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	Abdominal discomfort	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Asthenia	✓	·	✓
SD	Atrial hypertrophy	✓	·	✓
SD	Condition aggravated	·	·	✓
SD	Cough	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Mitral valve repair	✓	·	✓
SD	Monoplegia	·	·	✓
SD	Muscular weakness	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pre-existing disease	✓	·	✓
SD	Productive cough	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Sinus disorder	✓	✓	✓
SD	Throat clearing	✓	✓	✓
SD	Vision blurred	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Lethargy	✓	✓	✓
SRO	Productive cough	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sneezing	✓	✓	✓

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