Y6V-13547-46207

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

Sex: Male
Age at first dose: 66+
ZIP prefix: 461 / IN
Registered: 2021-03-20

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

2021-02-02
Dose 1 — Moderna
2021-03-02
Dose 2 — Moderna
2021-03-20
Registered in v-safe
2021-03-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-23
Survey response — day 21, dose 2
MedDRA: Diarrhoea, Myalgia — Feeling: Fair

Free text: Muscle aches. Diarrhea.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-13
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-01
Survey response — 3 months, dose 2
MedDRA: Diarrhoea, Dizziness, Respiratory tract congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: Diarrhea, congestion, dizziness. Sporadic but not attributable to any condition.Self treated

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-31
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-03
Dose 3 — Moderna
Co-administered: Flu
2022-03-02
Survey response — 12 months, dose 2
MedDRA: Dizziness, Gastrointestinal disorder, Oropharyngeal pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Sporadic, but cyclic, bowel problems. About 3-5 days of recovery before it starts again. Sudden dizziness. Lasts about 2 hours. Sore throat about once a week.

MedDRA releases: 2024-11 · check-in free text available
2022-07-20
Dose 4 — Moderna
2022-07-21
Survey response — days 1–6 daily, dose 4
MedDRA: Bowel movement irregularity — Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Nausea · Be unable to do your normal daily activities

Free text: Strange lower bowl activity. Started 3 days after booster #1

MedDRA releases: 2024-11 · check-in free text available
2022-07-22
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2022-07-23
Survey response — days 1–6 daily, dose 4
MedDRA: Irritable bowel syndrome — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Bowel irritation still exists

MedDRA releases: 2024-11 · check-in free text available
2022-07-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Joint pains

Adult check-in
2022-07-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Joint pains

Adult check-in
2022-07-26
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2022-07-27
Health check-in — day 7, dose 4
Feeling: Fair · Fever · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-08-03
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-08-10
Survey response — day 21, dose 4
MedDRA: Arthralgia, Asthenia, Dizziness, Headache — Feeling: Poor · Be unable to do your normal daily activities

Free text: Severe headache and top of shoulder pain last two days. Weak, dizzy at times

MedDRA releases: 2024-11 · check-in free text available
2022-08-17
Survey response — day 28, dose 4
MedDRA: Asthenia, Balance disorder, Dizziness — Feeling: Fair · Be unable to do your normal daily activities

Free text: Weak and dizzy. Loss of balance. Sporadic

MedDRA releases: 2024-11 · check-in free text available
2022-08-24
Survey response — day 35, dose 4
MedDRA: Arthralgia, Cough, Myalgia, Oropharyngeal pain, Pyrexia — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sore throat, fever, ache in shoulder and arm muscle, light cough

MedDRA releases: 2024-11 · check-in free text available
2022-08-24
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-08-25
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-31
Survey response — day 42, dose 4
MedDRA: Asthenia, Cough, Dizziness, SARS-CoV-2 test positive — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Weakness, dizzy, sporadic cough. POSITIVE Covid-19 test through Tues. Aug. 30

MedDRA releases: 2024-11 · check-in free text available
2022-08-31
Report sent to call center — day 42, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-09-01
Call successful
Participant prefers to complete VAERS report online
2022-10-19
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-01-19
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-02	Moderna
2	2021-03-02	Moderna
3	2021-11-03	Moderna	Flu
4	2022-07-20	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-08-24	Successful 2022-08-25	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-31	Successful 2022-09-01	Participant prefers to complete VAERS report online

Free text

Release 6 — day 21, dose 2

2021-03-23

Symptoms: Muscle aches. Diarrhea.

Release 8 — 3 months, dose 2

2021-06-01

Symptoms: Diarrhea, congestion, dizziness. Sporadic but not attributable to any condition.Self treated

Release 11 — 12 months, dose 2

2022-03-02

Symptoms: Sporadic, but cyclic, bowel problems. About 3-5 days of recovery before it starts again. Sudden dizziness. Lasts about 2 hours. Sore throat about once a week.

Release 12 — days 1–6 daily, dose 4

2022-07-21

Systemic reaction (other): Strange lower bowl activity. Started 3 days after booster #1

2022-07-23

Systemic reaction (other): Bowel irritation still exists

Release 12 — day 21, dose 4

2022-08-10

Symptoms: Severe headache and top of shoulder pain last two days. Weak, dizzy at times

Release 12 — day 28, dose 4

2022-08-17

Symptoms: Weak and dizzy. Loss of balance. Sporadic

Release 12 — day 35, dose 4

2022-08-24

Symptoms: Sore throat, fever, ache in shoulder and arm muscle, light cough

Release 12 — day 42, dose 4

2022-08-31

Symptoms: Weakness, dizzy, sporadic cough. POSITIVE Covid-19 test through Tues. Aug. 30

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	Balance disorder	·	·	✓
SD	Cough	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Headache	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	SARS-CoV-2 test positive	·	·	✓
SRO	Bowel movement irregularity	·	·	✓
SRO	Irritable bowel syndrome	·	·	✓

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