XYN-19295-80359

4 vaccinations 10 coded responses 38 check-ins 9 free-text entries 4 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 190 / PA
Registered: 2021-01-26

Relationship: Self
Race: White
Ethnicity: N/A

Timeline

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

2021-01-26
Registered in v-safe
2021-01-26
Dose 1 — Moderna
2021-01-26
Survey response — 0 day, dose 1
MedDRA: Hypoaesthesia, Pain in extremity — Feeling: Fair · Site: Pain · Fever · Headache, Nausea

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

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

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-02
Health check-in — 7 day, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — 14 day, dose 1
Feeling: Good

Adult check-in
2021-02-16
Health check-in — 21 day, dose 1
Feeling: Good

Adult check-in
2021-02-23
Health check-in — 28 day, dose 1
Feeling: Good

Adult check-in
2021-03-02
Health check-in — 35 day, dose 1
Feeling: Good

Adult check-in
2021-03-04
Dose 2 — Moderna
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — 7 day, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Survey response — 14 day, dose 2
MedDRA: Arthralgia — Feeling: Good

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-25
Survey response — 21 day, dose 2
MedDRA: Constipation — Feeling: Good

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-01
Survey response — 28 day, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-08
Health check-in — 35 day, dose 2
Feeling: Good

Adult check-in
2021-04-15
Health check-in — 42 day, dose 2
Feeling: Good

Adult check-in
2021-06-03
Survey response — 3 month, dose 2
MedDRA: Post herpetic neuralgia, Pre-existing disease — Feeling: Fair

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-09-02
Survey response — 6 month, dose 2
MedDRA: Herpes zoster, Neuralgia — Feeling: Fair

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-11-02
Dose 3 — Moderna
2022-03-04
Survey response — 12 month, dose 2
MedDRA: Arthralgia, Herpes zoster, Post herpetic neuralgia — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11 · check-in answers available
2022-03-04
Report sent to call center — 12 month, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-07
Call successful
Participant prefers to complete VAERS report online
2022-04-29
Dose 4 — Moderna
2022-04-29
Health check-in — 0 day, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-04-30
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches

Adult check-in
2022-05-01
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache, Joint pains

Adult check-in
2022-05-02
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-05-03
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Joint pains

Adult check-in
2022-05-04
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-05-05
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-05-06
Health check-in — 7 day, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-05-13
Health check-in — 14 day, dose 4
Feeling: Good

Adult check-in
2022-05-20
Health check-in — 21 day, dose 4
Feeling: Good

Adult check-in
2022-05-27
Health check-in — 28 day, dose 4
Feeling: Good

Adult check-in
2022-06-03
Survey response — 35 day, dose 4
MedDRA: Arthralgia, Injection site pain, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11 · check-in answers available
2022-06-03
Report sent to call center — 35 day, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-06
Call 1 — Left Voicemail
2022-06-06
Call 1 — Left Voicemail
2022-06-10
Health check-in — 42 day, dose 4
Feeling: Good

Adult check-in
2022-07-29
Health check-in — 3 month, dose 4
Feeling: Good

Adult check-in
2022-10-28
Survey response — 6 month, dose 4
MedDRA: COVID-19 — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11 · check-in answers available
2022-10-28
Report sent to call center — 6 month, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-31
Call 2 — Could Not Reach Participant
2022-10-31
Call 1 — Could Not Reach Participant
2022-11-03
Call successful
Participant prefers to complete VAERS report online
2022-11-03
Call successful
Participant prefers to complete VAERS report online
2023-04-29
Survey response — 12 month, dose 4
MedDRA: Bronchitis, Streptococcal infection — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11 · check-in answers available
2023-04-29
Report sent to call center — 12 month, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-05-02
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-26	Moderna
2	2021-03-04	Moderna
3	2021-11-02	Moderna	No
4	2022-04-29	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-03-04	Successful 2022-03-07	Participant prefers to complete VAERS report online
2022-06-03	Successful 2022-11-03	Participant prefers to complete VAERS report online
2022-10-28	Successful 2022-11-03	Participant prefers to complete VAERS report online
2023-04-29	Unsuccessful

Free text

Release 2

Systemic reaction (other): Pain on left side from neck to fingers. Slight numbness in left fingers. Injection was in left shoulder

Release 5

Symptoms: Pain on left side, especially hip

Release 6

Symptoms: Severe constipation

Symptoms: IBS

Release 8

Symptoms: Re-emergence of post-herpetic neuralgia from shingles

Release 9

Symptoms: Neuralgia from prior shingles lesions

Release 11

Symptoms: Hip pain

Healthcare visit (other): Cortisone injection, did not work. Post-herpetic neuralgia from shingles

Symptoms: Pain at injection site Strong hip pain where I previously had shingles

Release 12

Symptoms: I had Covid-19

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	Herpes zoster	·	·	✓
HCVO	Post herpetic neuralgia	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Bronchitis	·	·	✓
SD	Constipation	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Herpes zoster	✓	·	✓
SD	Injection site pain	·	·	✓
SD	Neuralgia	✓	·	✓
SD	Post herpetic neuralgia	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Streptococcal infection	·	·	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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