Y2B-19194-32850

2 vaccinations 12 coded responses 14 check-ins 12 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 757 / TX
Registered: 2021-03-05

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

2021-02-04
Dose 1 — Moderna
2021-03-05
Registered in v-safe
2021-03-05
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-03-19
Dose 2 — Moderna
2021-03-20
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain, Injection site pruritus — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: First injection sight much more pain and itching than the second shot, so far.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — days 1–6 daily, dose 2
MedDRA: Dysphagia — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Problems swallowing more than usual; I have had MS for 50+ years.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Survey response — days 1–6 daily, dose 2
MedDRA: Dysphagia, Dysphonia, Multiple sclerosis — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Hoarseness and difficulty swallowing. These are some of my newest, yet repeated, MS symptoms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Survey response — days 1–6 daily, dose 2
MedDRA: Dysphagia, Speech disorder — Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Vomiting, Diarrhea · Be unable to do your normal daily activities

Free text: Trouble talking and swallowing.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Survey response — days 1–6 daily, dose 2
MedDRA: Aphasia, Dysphagia — Feeling: Poor · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Free text: Still barely able to talk. Swallowing problems.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — day 7, dose 2
MedDRA: Choking, Dysphagia — Feeling: Poor · Site: Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Swallowing and choking

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — day 14, dose 2
MedDRA: Pre-existing disease, Restless legs syndrome — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: MS symptoms, but first time Ive had restless legs, while sleeping.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Survey response — day 21, dose 2
MedDRA: Musculoskeletal stiffness, Pain in extremity, Self-medication — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Trouble moving right hand. It's very stiff during daytime. I write daily, so I'm having trouble typing. Freezes up while I sleep. Wake up & have to rub fingers & hand for a long time. Right arm hurts and is stiff. I use lidocaine rub & spray many tim

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Survey response — day 28, dose 2
MedDRA: Choking, Dysphagia, Multiple sclerosis, Musculoskeletal stiffness, Pre-existing disease — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Right hand stiff and numb feeling. Probably my MS. Trouble swallowing, and choking.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Survey response — day 35, dose 2
MedDRA: Office visit, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Skin cancer on my face. · Healthcare visit (other): Dermatologist office

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-30
Survey response — day 42, dose 2
MedDRA: Unevaluable event — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Just have to have a new internal defibrillator installed, soon.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-18
Survey response — 6 months, dose 2
MedDRA: Cardiac disorder, Coronary artery occlusion, Deep vein thrombosis, Living in residential institution, Monoplegia, Myocardial infarction, Pain, Pre-existing disease, Stent placement — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: My 3rd defib and pacemaker surgery in 20 years, failed. Three weeks later 2 heart attacks, 100 percent one artery blocked, 2 stents, deep vein thrombosis felt me in extreme pain, and partially paralyzed in right leg. · Healthcare visit (other): Im in a nursing home care since heart issues.

MedDRA releases: 2024-11 · check-in free text available
2021-09-18
Report sent to call center — 6 months, 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

1 call case(s)
2021-09-21
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna
2	2021-03-19	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-04-26	Unsuccessful
2021-09-18	Unsuccessful

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-20

Systemic reaction (other): First injection sight much more pain and itching than the second shot, so far.

2021-03-22

Systemic reaction (other): Problems swallowing more than usual; I have had MS for 50+ years.

2021-03-23

Systemic reaction (other): Hoarseness and difficulty swallowing. These are some of my newest, yet repeated, MS symptoms.

2021-03-24

Systemic reaction (other): Trouble talking and swallowing.

2021-03-25

Systemic reaction (other): Still barely able to talk. Swallowing problems.

Release 6 — day 7, dose 2

2021-03-26

Systemic reaction (other): Swallowing and choking

Release 6 — day 14, dose 2

2021-04-05

Symptoms: MS symptoms, but first time Ive had restless legs, while sleeping.

Release 7 — day 21, dose 2

2021-04-10

Symptoms: Trouble moving right hand. It's very stiff during daytime. I write daily, so I'm having trouble typing. Freezes up while I sleep. Wake up & have to rub fingers & hand for a long time. Right arm hurts and is stiff. I use lidocaine rub & spray many tim cut off by CDC

Release 7 — day 28, dose 2

2021-04-16

Symptoms: Right hand stiff and numb feeling. Probably my MS. Trouble swallowing, and choking.

Release 8 — day 35, dose 2

2021-04-26

Symptoms: Skin cancer on my face.

Healthcare visit (other): Dermatologist office

Release 8 — day 42, dose 2

2021-04-30

Symptoms: Just have to have a new internal defibrillator installed, soon.

Release 9 — 6 months, dose 2

2021-09-18

Symptoms: My 3rd defib and pacemaker surgery in 20 years, failed. Three weeks later 2 heart attacks, 100 percent one artery blocked, 2 stents, deep vein thrombosis felt me in extreme pain, and partially paralyzed in right leg.

Healthcare visit (other): Im in a nursing home care since heart issues.

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
HCVO	Cardiac disorder	·	·	✓
HCVO	Living in residential institution	·	·	✓
HCVO	Office visit	✓	✓	✓
SD	Choking	✓	✓	✓
SD	Coronary artery occlusion	·	·	✓
SD	Deep vein thrombosis	·	·	✓
SD	Dysphagia	✓	✓	✓
SD	Monoplegia	·	·	✓
SD	Multiple sclerosis	✓	✓	✓
SD	Musculoskeletal stiffness	✓	✓	✓
SD	Myocardial infarction	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Restless legs syndrome	✓	✓	✓
SD	Self-medication	✓	✓	✓
SD	Stent placement	·	·	✓
SD	Unevaluable event	✓	✓	✓
SRO	Aphasia	✓	✓	✓
SRO	Choking	✓	✓	✓
SRO	Dysphagia	✓	✓	✓
SRO	Dysphonia	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Injection site pruritus	✓	✓	✓
SRO	Multiple sclerosis	✓	✓	✓
SRO	Speech disorder	✓	✓	✓

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