Y2W-17732-25950

3 vaccinations 7 coded responses 28 check-ins 7 free-text entries 3 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 775 / TX
Registered: 2021-01-18

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-15
Dose 1 — Moderna
2021-01-18
Registered in v-safe
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Redness · Fatigue or tiredness

Adult check-in
2021-01-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · Headache, Muscle or body aches

Adult check-in
2021-01-22
Health check-in — day 7, dose 1
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-12
Dose 2 — Moderna
2021-02-12
Health check-in — day 0, dose 2
Feeling: Fair · Site: Redness, Itching · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Vertigo — Feeling: Fair · Site: Pain, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: mild vertigo.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · Joint pains, Muscle or body aches

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Chills, Fatigue or tiredness

Adult check-in
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Good · Site: Pain · Headache

Free text: I now feeling much better as opposed to the last few days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-02-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-28
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-27
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-16
Survey response — 3 months, dose 2
MedDRA: Gingival abscess, Office visit, Tooth infection — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Gum absess with infection at root of tooth. None of which related to Covid exposure. · Healthcare visit (other): Dentist visit.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-14
Survey response — 6 months, dose 2
MedDRA: Fatigue, Influenza like illness, Pain, Pyrexia — Feeling: Good · Be unable to do your normal daily activities

Free text: Some minor fever and flu like symptoms for a week or so, with body aches & fatigue.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-15
Dose 3 — Moderna
2021-10-25
Health check-in — day 7, dose 3
Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-30
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-05
Survey response — day 21, dose 3
MedDRA: Fatigue, Headache, Malaise, Pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: General malaise and tiredness with a dull headache. No fever but having body aches.

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-26
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-15
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-15
Survey response — 6 months, dose 3
MedDRA: Cataract, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Mature cataract on right eye. Scheduled for eye surgery next week. · Healthcare visit (other): In office eye exam & surgical consultation.

MedDRA releases: 2024-11 · check-in free text available
2022-04-15
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-18
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-17
Survey response — 12 months, dose 3
MedDRA: Pancreaticoduodenectomy — Feeling: Fair · 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: Whipple Surgery 3 weeks ago.

MedDRA releases: 2024-11 · check-in free text available
2022-10-17
Report sent to call center — 12 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-10-18
Call successful
Not applicable - Accidental Reporting

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-12	Moderna
3	2021-10-15	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-05-16	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-15	Successful 2022-04-18	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-17	Successful 2022-10-18	Not applicable - Accidental Reporting

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-13

Systemic reaction (other): mild vertigo.

2021-02-16

Systemic reaction (other): I now feeling much better as opposed to the last few days.

Release 8 — 3 months, dose 2

2021-05-16

Symptoms: Gum absess with infection at root of tooth. None of which related to Covid exposure.

Healthcare visit (other): Dentist visit.

Release 9 — 6 months, dose 2

2021-08-14

Symptoms: Some minor fever and flu like symptoms for a week or so, with body aches & fatigue.

Release 10 — day 21, dose 3

2021-11-05

Symptoms: General malaise and tiredness with a dull headache. No fever but having body aches.

Release 11 — 6 months, dose 3

2022-04-15

Symptoms: Mature cataract on right eye. Scheduled for eye surgery next week.

Healthcare visit (other): In office eye exam & surgical consultation.

Release 12 — 12 months, dose 3

2022-10-17

Symptoms: Whipple Surgery 3 weeks ago.

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	Office visit	✓	✓	✓
SD	Cataract	·	·	✓
SD	Fatigue	✓	·	✓
SD	Gingival abscess	✓	✓	✓
SD	Headache	·	·	✓
SD	Influenza like illness	✓	·	✓
SD	Malaise	·	·	✓
SD	Pain	✓	·	✓
SD	Pancreaticoduodenectomy	·	·	✓
SD	Pyrexia	✓	·	✓
SD	Tooth infection	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Vertigo	✓	✓	✓

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