Y28-45797-56058

2 vaccinations 8 coded responses 13 check-ins 8 free-text entries 2 call cases

Sex: —
Age at first dose: 36-40
ZIP prefix: 107 / NY
Registered: 2021-05-12

Relationship: Self
Race: Other
Ethnicity: N/A

Timeline

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

2021-04-14
Dose 1 — Moderna
2021-05-12
Registered in v-safe
2021-05-12
Dose 2 — Moderna
2021-05-12
Survey response — day 0, dose 2
MedDRA: Paraesthesia — Feeling: Good · Site: Pain, Itching

Free text: Slight momentary tingling

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain, Pyrexia, Self-medication — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: I didnt take my temperature when i felt feverish until after I had taken ibuprofen. I had serious chest pain in the sternum but that was helped after 3 rounds of pain killers.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Good · Site: Pain · Fever · Muscle or body aches

Free text: Feeling woozy like my blood is racing in my head

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Poor · Fatigue or tiredness

Free text: It's hard to tell if my tiredness is due to the shot or from waking early and having wine with lunch. It's hard to know. I feel fine otherwise.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-26
Survey response — day 14, dose 2
MedDRA: Cough, Dehydration, Fatigue, Hypersomnia, Nasopharyngitis, Pain, Pyrexia, Sinus congestion, Sneezing — Feeling: Fair · Be unable to do your normal daily activities

Free text: I apparently have a cold with currenr and or recent sinus congestion, fever, feverish feeling (low temperature), aches, fatigue, coughing, sneezing, easy dehydration, lots of sleeping...

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Survey response — day 21, dose 2
MedDRA: Headache — Feeling: Fair

Free text: Minor headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-16
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-06-23
Survey response — day 42, dose 2
MedDRA: Viral pharyngitis — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Viral pharyngitis- it seems unrelated.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-23
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-30
Call 1 — Left Voicemail
2021-08-11
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-11-11
Survey response — 6 months, dose 2
MedDRA: Bacterial 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

Free text: Bacterial infection.

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Report sent to call center — 6 months, dose 2
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)
2021-11-15
Call 1 — Could Not Reach Participant
2021-11-18
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-05-12
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-14	Moderna
2	2021-05-12	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-06-23	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-11	Successful 2021-11-18	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 8 — day 0, dose 2

2021-05-12

Systemic reaction (other): Slight momentary tingling

Release 8 — days 1–6 daily, dose 2

2021-05-13

Systemic reaction (other): I didnt take my temperature when i felt feverish until after I had taken ibuprofen. I had serious chest pain in the sternum but that was helped after 3 rounds of pain killers.

2021-05-14

Systemic reaction (other): Feeling woozy like my blood is racing in my head

2021-05-15

Systemic reaction (other): It's hard to tell if my tiredness is due to the shot or from waking early and having wine with lunch. It's hard to know. I feel fine otherwise.

Release 8 — day 14, dose 2

2021-05-26

Symptoms: I apparently have a cold with currenr and or recent sinus congestion, fever, feverish feeling (low temperature), aches, fatigue, coughing, sneezing, easy dehydration, lots of sleeping...

Release 8 — day 21, dose 2

2021-06-02

Symptoms: Minor headache

Release 9 — day 42, dose 2

2021-06-23

Symptoms: Viral pharyngitis- it seems unrelated.

Release 10 — 6 months, dose 2

2021-11-11

Symptoms: Bacterial infection.

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	Bacterial infection	·	·	✓
SD	Cough	✓	✓	✓
SD	Dehydration	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypersomnia	✓	✓	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Sinus congestion	✓	✓	✓
SD	Sneezing	✓	✓	✓
SD	Viral pharyngitis	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Self-medication	✓	✓	✓

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