Y5U-50566-87495

2 vaccinations 9 coded responses 21 check-ins 9 free-text entries 2 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 300 / GA
Registered: 2021-03-16

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

2021-03-16
Registered in v-safe
2021-03-16
Dose 1 — Moderna
2021-03-16
Health check-in — day 0, dose 1
Feeling: Good · Fever · None

Adult check-in
2021-03-17
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling jittery, Tremor — Feeling: Good · Site: Pain

Free text: Seems like i had some jitters or shakes early in the day but subsided

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-20
Survey response — days 1–6 daily, dose 1
MedDRA: Emergency care, Medical counselling, Visual impairment — Feeling: Good

Free text: Had vision issues where it was recommended that i go top emergency room. All checked out and vision has improved

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Survey response — days 1–6 daily, dose 1
MedDRA: Visual impairment — Feeling: Good · Fever · Nausea

Free text: Still have vision issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — days 1–6 daily, dose 1
MedDRA: Visual impairment — Feeling: Good

Free text: Vision issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — day 7, dose 1
Feeling: Good · Headache

Adult check-in
2021-03-30
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-16
Survey response — day 28, dose 1
MedDRA: Localised infection — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Developed infection in leg for no apparent reason. No trauma. No cuts or bruising. Under antibiotic treatment now. Had for 12 days but our of the country for 10.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Report sent to call center — day 28, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-20
Dose 2 — Moderna
2021-04-22
Survey response — days 1–6 daily, dose 2
MedDRA: Anxiety, Confusional state, Dysarthria, Speech disorder — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to work

Free text: Confusion, anxiety, some garbled speech

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Insomnia, Swelling — Feeling: Good · Be unable to do your normal daily activities

Free text: Trouble sleeping. Still have unexplained swollen left foot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Survey response — days 1–6 daily, dose 2
MedDRA: Peripheral swelling — Feeling: Good · Be unable to do your normal daily activities

Free text: Foot swollen continues for day 22

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Survey response — day 7, dose 2
MedDRA: Office visit, Peripheral swelling — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Continued foot swelling · Healthcare visit (other): Primary care

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Report sent to call center — day 7, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-06
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-11
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-01
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-20
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-19
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-04-01
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-16	Moderna
2	2021-04-20	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-04-16	Unsuccessful
2021-04-27	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-17

Systemic reaction (other): Seems like i had some jitters or shakes early in the day but subsided

Release 6 — days 1–6 daily, dose 1

2021-03-20

Systemic reaction (other): Had vision issues where it was recommended that i go top emergency room. All checked out and vision has improved

2021-03-21

Systemic reaction (other): Still have vision issues

2021-03-22

Systemic reaction (other): Vision issues

Release 7 — day 28, dose 1

2021-04-16

Symptoms: Developed infection in leg for no apparent reason. No trauma. No cuts or bruising. Under antibiotic treatment now. Had for 12 days but our of the country for 10.

Release 7 — days 1–6 daily, dose 2

2021-04-22

Systemic reaction (other): Confusion, anxiety, some garbled speech

2021-04-23

Systemic reaction (other): Trouble sleeping. Still have unexplained swollen left foot

2021-04-25

Systemic reaction (other): Foot swollen continues for day 22

Release 8 — day 7, dose 2

2021-04-27

Systemic reaction (other): Continued foot swelling

Healthcare visit (other): Primary care

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	Localised infection	✓	✓	✓
SRO	Anxiety	✓	✓	✓
SRO	Confusional state	✓	✓	✓
SRO	Dysarthria	✓	·	✓
SRO	Emergency care	✓	✓	✓
SRO	Feeling jittery	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Medical counselling	·	·	✓
SRO	Peripheral swelling	✓	✓	✓
SRO	Speech disorder	○	✓	○
SRO	Swelling	✓	✓	✓
SRO	Tremor	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

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