Y5H-95514-52547

4 vaccinations 8 coded responses 29 check-ins 7 free-text entries 3 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 007 / PR
Registered: 2021-01-22

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-01-22
Registered in v-safe
2021-01-22
Dose 1 — Moderna
2021-01-22
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-19
Dose 2 — Moderna
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite — Feeling: Fair · Site: Pain, Redness, Itching · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Loss of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Survey response — day 7, dose 2
MedDRA: Peripheral swelling — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Joint pains, Muscle or body aches

Free text: 2 right hand center fingers swollen badly that opened skin

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Survey response — day 14, dose 2
MedDRA: Arthralgia, Back pain, Condition aggravated, Pain, Pre-existing disease, Psoriasis — Feeling: Fair

Free text: Pre existing pains have become stronger, for example psoriasis related pains in joints, articulations and back. Neuralgic pre existing pains as well.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-29
Survey response — day 35, dose 2
MedDRA: Arthralgia — Feeling: Fair

Free text: Pain in specific joints

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Survey response — day 42, dose 2
MedDRA: Office visit, Peripheral swelling, Pre-existing disease, Psoriasis, Skin fissures — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Swelling of hands leading to crack skin and worsening psoriasis symptoms · Healthcare visit (other): Visit to my doctor.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-24
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-06-10
Call 1 — Could Not Reach Participant
2021-06-15
Call 2 — Could Not Reach Participant
2021-08-20
Survey response — 6 months, dose 2
MedDRA: Cough, Fatigue, Headache, Pain, Patient isolation, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Positive with COVID, tested twice. Runny nose , no fever but body pains, cough, stuffiness around nose and mouth, felt tired , headache. State COVID agency kept track daily and yesterday me and wife were declared safe after 14 day isolation.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-20
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-27
Call 1 — Could Not Reach Participant
2021-09-01
Call 2 — Could Not Reach Participant
2021-10-23
Dose 3 — Moderna
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Diarrhea

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Diarrhea

Adult check-in
2021-10-30
Health check-in — day 7, dose 3
Feeling: Good · Diarrhea

Adult check-in
2021-11-09
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-14
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-20
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-29
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-05
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-28
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-10
Dose 4 — Moderna
2022-05-18
Health check-in — day 7, dose 4
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-25
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-01
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-07
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-14
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-22
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-12
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-08
Survey response — 6 months, dose 4
MedDRA: Pain — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Body pains

MedDRA releases: 2024-11 · check-in free text available
2022-11-08
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-09
Call 3 — Could Not Reach Participant
2022-11-09
Call 3 — Could Not Reach Participant
2022-11-09
Call 1 — Could Not Reach Participant
2022-11-14
Call X — Could Not Reach Participant
2022-11-14
Call X — Could Not Reach Participant
2022-11-14
Call 2 — Could Not Reach Participant
2023-05-13
Survey response — 12 months, dose 4
MedDRA: COVID-19 — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Moderna
2	2021-02-19	Moderna
3	2021-10-23	Moderna	No
4	2022-05-10	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-02	Unsuccessful
2021-08-20	Unsuccessful
2022-11-08	Unsuccessful

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-20

Systemic reaction (other): Loss of appetite

Release 4 — day 7, dose 2

2021-02-26

Systemic reaction (other): 2 right hand center fingers swollen badly that opened skin

Release 5 — day 14, dose 2

2021-03-06

Symptoms: Pre existing pains have become stronger, for example psoriasis related pains in joints, articulations and back. Neuralgic pre existing pains as well.

Release 6 — day 35, dose 2

2021-03-29

Symptoms: Pain in specific joints

Release 6 — day 42, dose 2

2021-04-02

Symptoms: Swelling of hands leading to crack skin and worsening psoriasis symptoms

Healthcare visit (other): Visit to my doctor.

Release 9 — 6 months, dose 2

2021-08-20

Symptoms: Positive with COVID, tested twice. Runny nose , no fever but body pains, cough, stuffiness around nose and mouth, felt tired , headache. State COVID agency kept track daily and yesterday me and wife were declared safe after 14 day isolation.

Release 12 — 6 months, dose 4

2022-11-08

Symptoms: Body pains

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	Arthralgia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Cough	✓	·	✓
SD	COVID-19	·	·	✓
SD	Fatigue	✓	·	✓
SD	Headache	✓	·	✓
SD	Pain	✓	✓	✓
SD	Patient isolation	✓	·	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Psoriasis	✓	✓	✓
SD	Respiratory tract congestion	✓	·	✓
SD	Rhinorrhoea	✓	·	✓
SD	SARS-CoV-2 test positive	✓	·	✓
SD	Skin fissures	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓

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