Y4J-66794-63284

4 vaccinations 19 coded responses 50 check-ins 18 free-text entries 1 call case

Sex: Male
Age at first dose: 61-65
ZIP prefix: 201 / VA
Registered: 2021-04-24

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

2021-04-23
Dose 1 — Moderna
2021-04-24
Registered in v-safe
2021-04-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fever · Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-28
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Abdominal pain

Adult check-in
2021-04-30
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-05-07
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-14
Survey response — day 21, dose 1
MedDRA: Fatigue — Feeling: Good

Free text: Fatigue. Major fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Dose 2 — Moderna
2021-05-21
Health check-in — day 0, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-05-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-23
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-24
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-05-26
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased, Pain — Feeling: Good · Be unable to do your normal daily activities

Free text: Rapid heart rate, 115 stationary, 150 with pain when I walk to the kitchen

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Survey response — days 1–6 daily, dose 2
MedDRA: Altered visual depth perception, Balance disorder, Dizziness, Pre-existing disease, Vertigo — Feeling: Good

Free text: Poor balance. I had COVID last May, balance was a serious problem for all of 2020. Very weird for it to come back so hard today. It's NOT dizziness. It's like my perception of the world around me if off by 3 degrees, everything is on an incline

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-28
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-06-04
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-11
Survey response — day 21, dose 2
MedDRA: Muscle spasms — Feeling: Good

Free text: Muscle cramps and spasms continue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-18
Survey response — day 28, dose 2
MedDRA: Asthenia, Chest pain, Fatigue, Heart rate increased, Hypertension, Pyrexia — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Rise in sitting Heart rate to above 100, and blood pressure. Occasional pain in chest. On and off low grade fever. Extreme fatigue, lack of energy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-25
Survey response — day 35, dose 2
MedDRA: Chest pain, Fatigue, Heart rate increased, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Slight fever 100.7, pain in chest. Heart rate between 98-146, fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-02
Survey response — day 42, dose 2
MedDRA: Arthralgia, Diarrhoea, Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Diarrhea, joint pain in knees, FATIGUE

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-20
Survey response — 3 months, dose 2
MedDRA: Pain, Pain in extremity — 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

Free text: Horrible pain radiating down my right leg.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-20
Report sent to call center — 3 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)
2021-08-26
Call 1 — Left Voicemail
2021-11-19
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-11-23
Dose 3 — Moderna
2021-11-24
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-11-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-11-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-11-27
Survey response — days 1–6 daily, dose 3
MedDRA: Balance disorder — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Loss of balance

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-11-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-11-30
Health check-in — day 7, dose 3
Feeling: Good · Fatigue or tiredness, Diarrhea

Adult check-in
2021-12-07
Survey response — day 14, dose 3
MedDRA: Fatigue — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Fatigue

MedDRA releases: 2024-11 · check-in free text available
2021-12-14
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-21
Survey response — day 28, dose 3
MedDRA: Tachycardia — Feeling: Good · Be unable to do your normal daily activities

Free text: Tachycardia

MedDRA releases: 2024-11 · check-in free text available
2021-12-28
Survey response — day 35, dose 3
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Greater fatigue than usual

MedDRA releases: 2024-11 · check-in free text available
2022-01-04
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-02-22
Survey response — 3 months, dose 3
MedDRA: Tinnitus, Visual impairment — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Visual disturbances, Lord hissing in my ears

MedDRA releases: 2024-11 · check-in free text available
2022-04-08
Dose 4 — Moderna
2022-04-08
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-04-09
Survey response — days 1–6 daily, dose 4
MedDRA: Tachycardia — Feeling: Poor · Site: Pain · Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Tachycardia, HR between 125-150 all day

MedDRA releases: 2024-11 · check-in free text available
2022-04-12
Survey response — days 1–6 daily, dose 4
MedDRA: Fatigue — Feeling: Fair · Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: So much fatigue...

MedDRA releases: 2024-11 · check-in free text available
2022-04-13
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2022-04-14
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness, Diarrhea

Adult check-in
2022-04-15
Health check-in — day 7, dose 4
Feeling: Good · Fatigue or tiredness, Diarrhea

Adult check-in
2022-04-22
Survey response — day 14, dose 4
MedDRA: Arthralgia, Back pain, Muscle spasms — Feeling: Fair · Be unable to do your normal daily activities

Free text: Muscle spasms/ pain in shoulders, good, knee and lower back

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Survey response — day 21, dose 4
MedDRA: Arthralgia, Flank pain — Feeling: Good · Be unable to do your normal daily activities

Free text: Joint & middle pain. Mostly right side. Shoulder hip and knee

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
Survey response — day 28, dose 4
MedDRA: Arthralgia, Myalgia — Feeling: Good · Be unable to do your normal daily activities

Free text: Muscle/ joint pain is increasing

MedDRA releases: 2024-11 · check-in free text available
2022-05-13
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-20
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-08
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-04-08
Survey response — 12 months, dose 4
MedDRA: Neuropathy peripheral — Feeling: Fair · Be unable to work or attend school

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-23	Moderna
2	2021-05-21	Moderna
3	2021-11-23	Moderna	No
4	2022-04-08	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-08-20	Unsuccessful

Free text

Release 8 — day 21, dose 1

2021-05-14

Symptoms: Fatigue. Major fatigue.

Release 8 — days 1–6 daily, dose 2

2021-05-26

Systemic reaction (other): Rapid heart rate, 115 stationary, 150 with pain when I walk to the kitchen

2021-05-27

Systemic reaction (other): Poor balance. I had COVID last May, balance was a serious problem for all of 2020. Very weird for it to come back so hard today. It's NOT dizziness. It's like my perception of the world around me if off by 3 degrees, everything is on an incline

Release 9 — day 21, dose 2

2021-06-11

Symptoms: Muscle cramps and spasms continue.

Release 9 — day 28, dose 2

2021-06-18

Symptoms: Rise in sitting Heart rate to above 100, and blood pressure. Occasional pain in chest. On and off low grade fever. Extreme fatigue, lack of energy.

Release 9 — day 35, dose 2

2021-06-25

Symptoms: Slight fever 100.7, pain in chest. Heart rate between 98-146, fatigue

Release 9 — day 42, dose 2

2021-07-02

Symptoms: Diarrhea, joint pain in knees, FATIGUE

Release 9 — 3 months, dose 2

2021-08-20

Symptoms: Horrible pain radiating down my right leg.

Release 10 — days 1–6 daily, dose 3

2021-11-27

Systemic reaction (other): Loss of balance

Release 10 — day 14, dose 3

2021-12-07

Symptoms: Fatigue

Release 10 — day 28, dose 3

2021-12-21

Symptoms: Tachycardia

Release 10 — day 35, dose 3

2021-12-28

Symptoms: Greater fatigue than usual

Release 11 — 3 months, dose 3

2022-02-22

Symptoms: Visual disturbances, Lord hissing in my ears

Release 11 — days 1–6 daily, dose 4

2022-04-09

Systemic reaction (other): Tachycardia, HR between 125-150 all day

2022-04-12

Systemic reaction (other): So much fatigue...

Release 11 — day 14, dose 4

2022-04-22

Symptoms: Muscle spasms/ pain in shoulders, good, knee and lower back

Release 11 — day 21, dose 4

2022-04-29

Symptoms: Joint & middle pain. Mostly right side. Shoulder hip and knee

Release 11 — day 28, dose 4

2022-05-06

Symptoms: Muscle/ joint pain is increasing

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	Arthralgia	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Back pain	·	·	✓
SD	Chest pain	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Flank pain	·	·	✓
SD	Heart rate increased	✓	✓	✓
SD	Hypertension	✓	✓	✓
SD	Muscle spasms	✓	✓	✓
SD	Myalgia	·	·	✓
SD	Neuropathy peripheral	·	·	✓
SD	Pain	✓	·	✓
SD	Pain in extremity	✓	·	✓
SD	Pyrexia	✓	✓	✓
SD	Tachycardia	·	·	✓
SD	Tinnitus	·	·	✓
SD	Visual impairment	·	·	✓
SRO	Altered visual depth perception	·	·	✓
SRO	Balance disorder	✓	✓	✓
SRO	Dizziness	✓	✓	○
SRO	Fatigue	·	·	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pre-existing disease	·	·	✓
SRO	Tachycardia	·	·	✓
SRO	Vertigo	✓	✓	○

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