YA3-24656-48839

2 vaccinations 10 coded responses 25 check-ins 10 free-text entries 1 call case

Sex: Male
Age at first dose: 61-65
ZIP prefix: 373 / TN
Registered: 2021-11-11

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

2021-11-10
Dose 1 — Moderna
2021-11-11
Registered in v-safe
2021-11-11
Survey response — days 1–6 daily, dose 1
MedDRA: Paraesthesia — Feeling: Good · Fever · Chills, Headache, Muscle or body aches

Free text: Skin "tingles" arms, legs

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Survey response — days 1–6 daily, dose 1
MedDRA: Paraesthesia, Pyrexia — Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea

Free text: My skin always feels "prickly". All is better today. From 3p.m. 11/11 to 7:00 a.m. 11/12 I ran a fever between 100 F to 101.7 F

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Survey response — days 1–6 daily, dose 1
MedDRA: Adverse reaction — Feeling: Good · Chills, Headache

Free text: I'm much better today

MedDRA releases: 2024-11 · check-in free text available
2021-11-14
Survey response — days 1–6 daily, dose 1
MedDRA: Adverse reaction — Feeling: Good · Headache

Free text: I'm feeling much better

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Survey response — days 1–6 daily, dose 1
MedDRA: Adverse reaction, Body temperature increased, Headache — Feeling: Good · Headache

Free text: I'm feeling much better. The headache- like sinus- top and back of my head, is all that's left. Temp is 98.1 - 98.8 F since 11/14 a.m. Thank you

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-11-17
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-11-24
Survey response — day 14, dose 1
MedDRA: Cough, Influenza, Nasopharyngitis, Office visit, Pharyngeal erythema, Upper-airway cough syndrome — Feeling: Good · Be unable to work or attend school, 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: Cold Flu symptoms on 11/22. Went to walk-in urgent care. No fever. Cough, red throat (inside), nasal drip. Rx: Azithromycin 250mg, x2 day1, x1 day 2,3,4. Prednisone 250mg x2 day 1, 2, 3, 4. Tussiin 2tsp x4/day. Rest and water.

MedDRA releases: 2024-11 · check-in free text available
2021-11-24
Report sent to call center — day 14, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-01
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-12-08
Survey response — day 28, dose 1
MedDRA: Cough, Paranasal sinus hypersecretion — Feeling: Fair

Free text: Sinus drainage and coughing.

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Dose 2 — Moderna
2021-12-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-12-12
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Chills, Fatigue or tiredness

Free text: Deep chest cough. It could be coincidental. I had a cough before the vaccine.

MedDRA releases: 2024-11 · check-in free text available
2021-12-13
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease — Feeling: Good · Diarrhea

Free text: I feel lots better. Dr (b)(6) started me on doxycycline for symptoms previous to vaccine on 12/10.

MedDRA releases: 2024-11 · check-in free text available
2021-12-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-12-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-12-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-12-17
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-12-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-12-31
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2022-01-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2022-01-13
Call 1 — Left Voicemail
2022-01-13
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2022-01-21
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2022-03-11
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-06-10
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-12-10
Survey response — 12 months, dose 2
MedDRA: Influenza — Feeling: Good · Be unable to work or attend school

Free text: I had the flu last week. (7 days after my flu vaccination-not long enough for the vaccine to have taken affect). I'm better now

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-11-10	Moderna	No
2	2021-12-10	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-11-24	Successful 2022-01-13	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 10 — days 1–6 daily, dose 1

2021-11-11

Systemic reaction (other): Skin "tingles" arms, legs

2021-11-12

Systemic reaction (other): My skin always feels "prickly". All is better today. From 3p.m. 11/11 to 7:00 a.m. 11/12 I ran a fever between 100 F to 101.7 F

2021-11-13

Systemic reaction (other): I'm much better today

2021-11-14

Systemic reaction (other): I'm feeling much better

2021-11-15

Systemic reaction (other): I'm feeling much better. The headache- like sinus- top and back of my head, is all that's left. Temp is 98.1 - 98.8 F since 11/14 a.m. Thank you

Release 10 — day 14, dose 1

2021-11-24

Symptoms: Cold Flu symptoms on 11/22. Went to walk-in urgent care. No fever. Cough, red throat (inside), nasal drip. Rx: Azithromycin 250mg, x2 day1, x1 day 2,3,4. Prednisone 250mg x2 day 1, 2, 3, 4. Tussiin 2tsp x4/day. Rest and water.

Release 10 — day 28, dose 1

2021-12-08

Symptoms: Sinus drainage and coughing.

Release 10 — days 1–6 daily, dose 2

2021-12-12

Systemic reaction (other): Deep chest cough. It could be coincidental. I had a cough before the vaccine.

2021-12-13

Systemic reaction (other): I feel lots better. Dr (b)(6) started me on doxycycline for symptoms previous to vaccine on 12/10.

redacted (b)(6)

Release 12 — 12 months, dose 2

2022-12-10

Symptoms: I had the flu last week. (7 days after my flu vaccination-not long enough for the vaccine to have taken affect). I'm better now

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	Cough	·	·	✓
SD	Influenza	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Office visit	·	·	✓
SD	Paranasal sinus hypersecretion	·	·	✓
SD	Pharyngeal erythema	·	·	✓
SD	Upper-airway cough syndrome	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Body temperature increased	·	·	✓
SRO	Headache	·	·	✓
SRO	Paraesthesia	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Pyrexia	·	·	✓

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