Y8R-12893-70577

5 vaccinations 9 coded responses 41 check-ins 9 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 109 / NY
Registered: 2021-02-04

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

2021-02-04
Registered in v-safe
2021-02-04
Dose 1 — Moderna
2021-02-04
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-05
Survey response — days 1–6 daily, dose 1
MedDRA: Emergency care, Muscle spasms — Feeling: Poor · Muscle or body aches · Be unable to do your normal daily activities

Free text: Severe muscle cramping in my neck. Had to go to hospital for treatment. Possibly not due to the vaccination

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 1
MedDRA: Muscle spasms — Feeling: Fair · Muscle or body aches · Be unable to do your normal daily activities

Free text: Muscle spasams. See yesterdays report.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-11
Health check-in — day 7, dose 1
Feeling: Fair · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-04
Dose 2 — Moderna
2021-03-04
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · None

Adult check-in
2021-03-11
Survey response — day 7, dose 2
MedDRA: Cough, Nasopharyngitis — Feeling: Good · Fatigue or tiredness

Free text: Over the last few days felt like a common nose cold which turned into a deep cough yesterday. Totally gone today. Could this have been a delayed reaction to my 2nd vacc. dose on days 4, 5 and 6?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-03
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-04
Dose 3 — Moderna
2022-03-06
Survey response — 12 months, dose 2
MedDRA: Malaise, Nasal congestion, Rhinorrhoea — Feeling: Fair

Free text: Runny nose. Stuffy and feeling like I'm coming down with something.

MedDRA releases: 2024-11 · check-in free text available
2022-04-18
Dose 4 — Pfizer-BioNTech
2022-04-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-25
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-02
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-11
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-16
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-30
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-18
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-03
Dose 5 — Moderna
2022-09-25
Survey response — day 21, dose 5
MedDRA: Inguinal hernia — Feeling: Good · Get care from a doctor or other healthcare professional · Hospitalization

Free text: inguinal hernia

MedDRA releases: 2024-11 · check-in free text available
2022-09-25
Report sent to call center — day 21, dose 5
Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-09-26
Call 1 — Left Voicemail
2022-10-01
Survey response — day 28, dose 5
MedDRA: Eczema, Pre-existing disease — Feeling: Fair

Free text: Big Eczema flair up

MedDRA releases: 2024-11 · check-in free text available
2022-10-08
Survey response — day 35, dose 5
MedDRA: Office visit, Rash — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Major rash over entire chest and abdomen · Healthcare visit (other): dr office visit

MedDRA releases: 2024-11 · check-in free text available
2022-10-08
Report sent to call center — day 35, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-10-11
Call 2 — Left Voicemail
2022-10-11
Call 1 — Left Voicemail
2022-10-15
Survey response — day 42, dose 5
MedDRA: Pyrexia — 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: Severe reaction with high fever to flu vaccine.

MedDRA releases: 2024-11 · check-in free text available
2022-10-15
Report sent to call center — day 42, dose 5
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)
2022-10-17
Call 3 — Left Voicemail
2022-10-17
Call 2 — Left Voicemail
2022-10-17
Call 1 — Left Voicemail
2022-12-03
Survey response — 3 months, dose 5
MedDRA: Dermatitis contact, Eczema, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Eczema (contact dermatitis) · Healthcare visit (other): Doctor's office visit

MedDRA releases: 2024-11 · check-in free text available
2022-12-03
Report sent to call center — 3 months, dose 5
Get care from a doctor or other healthcare professional

1 call case(s)
2022-12-05
Call X — Left Voicemail
2022-12-05
Call 3 — Left Voicemail
2022-12-05
Call 2 — Left Voicemail
2022-12-05
Call 1 — Left Voicemail
2023-03-04
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna
2	2021-03-04	Moderna
3	2021-11-04	Moderna	No
4	2022-04-18	Pfizer-BioNTech	No
5	2022-09-03	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-09-25	Unsuccessful
2022-10-08	Unsuccessful
2022-10-15	Unsuccessful
2022-12-03	Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-05

Systemic reaction (other): Severe muscle cramping in my neck. Had to go to hospital for treatment. Possibly not due to the vaccination

2021-02-06

Systemic reaction (other): Muscle spasams. See yesterdays report.

Release 5 — day 7, dose 2

2021-03-11

Systemic reaction (other): Over the last few days felt like a common nose cold which turned into a deep cough yesterday. Totally gone today. Could this have been a delayed reaction to my 2nd vacc. dose on days 4, 5 and 6?

Release 11 — 12 months, dose 2

2022-03-06

Symptoms: Runny nose. Stuffy and feeling like I'm coming down with something.

Release 12 — day 21, dose 5

2022-09-25

Symptoms: inguinal hernia

Release 12 — day 28, dose 5

2022-10-01

Symptoms: Big Eczema flair up

Release 12 — day 35, dose 5

2022-10-08

Symptoms: Major rash over entire chest and abdomen

Healthcare visit (other): dr office visit

Release 12 — day 42, dose 5

2022-10-15

Symptoms: Severe reaction with high fever to flu vaccine.

Release 12 — 3 months, dose 5

2022-12-03

Symptoms: Eczema (contact dermatitis)

Healthcare visit (other): Doctor's office visit

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	Dermatitis contact	·	·	✓
SD	Eczema	·	·	✓
SD	Inguinal hernia	·	·	✓
SD	Malaise	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rash	·	·	✓
SD	Rhinorrhoea	·	·	✓
SRO	Cough	✓	✓	✓
SRO	Emergency care	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓
SRO	Nasopharyngitis	✓	✓	✓

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