Y8C-21240-90703

4 vaccinations 11 coded responses 53 check-ins 11 free-text entries 3 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 405 / KY
Registered: 2021-01-04

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

2021-01-04
Registered in v-safe
2021-01-04
Dose 1 — Moderna
2021-01-04
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-01
Dose 2 — Moderna
2021-02-02
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling abnormal — Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: I feel Wicked. Felt fine this morning.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Itching · Fatigue or tiredness

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · None

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-02-08
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-03
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-02
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-09-22
Dose 3 — Moderna
2021-09-23
Survey response — days 1–6 daily, dose 3
MedDRA: Impaired driving ability — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: It was hard to drive

MedDRA releases: 2024-11 · check-in free text available
2021-09-24
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-09-25
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue, Memory impairment — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Fatigue and forgetting things is the worst.

MedDRA releases: 2024-11 · check-in free text available
2021-09-26
Survey response — days 1–6 daily, dose 3
MedDRA: Headache, Respiratory tract congestion, Sinusitis — Feeling: Fair · Headache

Free text: Congestion with a HA which Im pretty sure is a sinus problem nfection

MedDRA releases: 2024-11 · check-in free text available
2021-09-27
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Respiratory tract congestion, Sinusitis — Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness

Free text: Sinusitis and congestion with a cough

MedDRA releases: 2024-11 · check-in free text available
2021-09-28
Survey response — days 1–6 daily, dose 3
MedDRA: Oedema, Office visit, Pre-existing disease, Sinusitis — Feeling: Fair · Fever · Headache, Fatigue or tiredness, Diarrhea · Be unable to work or attend school, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): The main reason is a sinus infection with tissue swelling and I am treated by Dr. (b)(6). He thinks it could have been triggered by the Covid vaccines but Ive had sinus problems all my life with multiple surgeries (~17) · Healthcare visit (other): ENT office visit and scoped, then prescribed Augmentin and high dose Prednisone.

MedDRA releases: 2024-11 · check-in free text available
2021-09-28
Report sent to call center — days 1–6 daily, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-29
Survey response — day 7, dose 3
MedDRA: Sinusitis — Feeling: Fair · Fever · Chills · Be unable to work or attend school

Free text: Sinusitis

MedDRA releases: 2024-11 · check-in free text available
2021-10-01
Call 1 — Left Voicemail
2021-10-06
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-10-13
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-10-20
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-10-27
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-11-03
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-22
Survey response — 3 months, dose 3
MedDRA: Sinusitis — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sinusitis

MedDRA releases: 2024-11 · check-in free text available
2021-12-22
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-23
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-03-23
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-06-10
Dose 4 — Moderna
2022-06-10
Survey response — day 0, dose 4
MedDRA: No adverse event — Feeling: Good

Free text: I just received it at 15:30 so it's too early to tell

MedDRA releases: 2024-11 · check-in free text available
2022-06-11
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-06-12
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-06-13
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-06-14
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-06-15
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Diarrhea

Adult check-in
2022-06-16
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Diarrhea

Adult check-in
2022-06-17
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-06-24
Survey response — day 14, dose 4
MedDRA: Atrial fibrillation, Bradycardia, Costochondritis, Hospitalisation — Feeling: Good · Be unable to work or attend school

Free text: Costochondritis with A-fib and bradycardia in the hospital. Not Covid.

MedDRA releases: 2024-11 · check-in free text available
2022-07-01
Survey response — day 21, dose 4
MedDRA: Atrial fibrillation, Costochondritis, Hospitalisation, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Not that this is related, however I spent 4 days at (b)(6) Hospital (b)(6), Ky, due to Costochondritis and Atrial Fibrillation. 6/23-6/27. I did have a negative PCR for Covid while there.

MedDRA releases: 2024-11 · check-in free text available
2022-07-01
Report sent to call center — day 21, dose 4
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-07-05
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-08
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-07-15
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-22
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-09-09
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-12-09
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-06-10
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-02-01	Moderna
3	2021-09-22	Moderna	No
4	2022-06-10	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-28	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-12-22	Successful 2021-12-23	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-01	Successful 2022-07-05	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 3 — days 1–6 daily, dose 2

2021-02-02

Systemic reaction (other): I feel Wicked. Felt fine this morning.

Release 9 — days 1–6 daily, dose 3

2021-09-23

Systemic reaction (other): It was hard to drive

2021-09-25

Systemic reaction (other): Fatigue and forgetting things is the worst.

2021-09-26

Systemic reaction (other): Congestion with a HA which Im pretty sure is a sinus problem nfection

2021-09-27

Systemic reaction (other): Sinusitis and congestion with a cough

2021-09-28

Systemic reaction (other): The main reason is a sinus infection with tissue swelling and I am treated by Dr. (b)(6). He thinks it could have been triggered by the Covid vaccines but Ive had sinus problems all my life with multiple surgeries (~17)

Healthcare visit (other): ENT office visit and scoped, then prescribed Augmentin and high dose Prednisone.

redacted (b)(6)

Release 9 — day 7, dose 3

2021-09-29

Systemic reaction (other): Sinusitis

Release 10 — 3 months, dose 3

2021-12-22

Symptoms: Sinusitis

Release 12 — day 0, dose 4

2022-06-10

Systemic reaction (other): I just received it at 15:30 so it's too early to tell

Release 12 — day 14, dose 4

2022-06-24

Symptoms: Costochondritis with A-fib and bradycardia in the hospital. Not Covid.

Release 12 — day 21, dose 4

2022-07-01

Symptoms: Not that this is related, however I spent 4 days at (b)(6) Hospital (b)(6), Ky, due to Costochondritis and Atrial Fibrillation. 6/23-6/27. I did have a negative PCR for Covid while there.

redacted (b)(6)

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	Atrial fibrillation	·	·	✓
SD	Bradycardia	·	·	✓
SD	Costochondritis	·	·	✓
SD	Hospitalisation	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinusitis	·	·	✓
SRO	Cough	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Headache	·	·	✓
SRO	Impaired driving ability	·	·	✓
SRO	Memory impairment	·	·	✓
SRO	No adverse event	·	·	✓
SRO	Oedema	·	·	✓
SRO	Office visit	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Respiratory tract congestion	·	·	✓
SRO	Sinusitis	·	·	✓

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