YA6-24057-36555

4 vaccinations 18 coded responses 40 check-ins 17 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 458 / OH
Registered: 2021-03-05

Relationship: Self
Race: N/A
Ethnicity: N/A

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-03-05
Registered in v-safe
2021-03-05
Dose 1 — Moderna
2021-03-05
Health check-in — day 0, dose 1
Feeling: Good · Site: Itching · None

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

Adult check-in
2021-03-07
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Good · Site: Pain

Free text: The arm pain is barely noticeable!!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Site: Pain

Free text: The pain is barely noticeable I have to press my hand on the site to feel it!

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

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

Adult check-in
2021-03-12
Health check-in — day 7, dose 1
Feeling: Fair · Abdominal pain

Adult check-in
2021-03-20
Survey response — day 14, dose 1
MedDRA: Abdominal pain, Diarrhoea, Emergency care, SARS-CoV-2 test negative, Vomiting — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Serious vomiting & diarrhea plus minor abdominal pain. · Healthcare visit (other): The hospital did make CV19 test & it was negative!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 14, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-26
Survey response — day 21, dose 1
MedDRA: Biliary colic, Gallbladder disorder — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: They discovered that my Gallbladder has a serious problem. Plus it is creating a lot of pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Report sent to call center — day 21, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-04
Survey response — day 28, dose 1
MedDRA: Cholecystectomy, Gallbladder disorder — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: It turns out I had a bad gallbladder. But that has been removed and things seem to be on an upswing.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
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)
2021-04-07
Dose 2 — Moderna
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-11
Survey response — days 1–6 daily, dose 2
MedDRA: Pain — Feeling: Good · Site: Pain

Free text: The pain is so mild if I dont think about it it is noticeable.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-13
Survey response — days 1–6 daily, dose 2
MedDRA: Cholecystectomy, Decreased appetite — Feeling: Good · Diarrhea

Free text: I had my gallbladder out 2 weeks ago & food does not appeal much. This is different than the surgeon said. He said I could eat normally but not greasy food or caffeine. Is my lack of interest due to operation or vaccine?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — day 7, dose 2
MedDRA: Pain — Feeling: Fair · Abdominal pain

Free text: Slight pain that is better today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Survey response — day 14, dose 2
MedDRA: Abdominal pain, Malaise — Feeling: Fair · Be unable to do your normal daily activities

Free text: Abdominal pains and a feeling of malaise.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-05
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-12
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-19
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-15
Call 2 — Left Voicemail
2021-07-07
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-06
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-30
Dose 3 — Moderna
2022-04-07
Dose 4 — Moderna
2022-04-07
Survey response — 12 months, dose 2
MedDRA: Arthralgia, Cough — Feeling: Good

Free text: Mild pain in my Rt shoulder. Additionally frequently coughing (This was not occurring prior to the injection). I cannot tell if it is related to the shot. I did not have a caugh prior to the shot. It started about 12 hours later.

MedDRA releases: 2024-11 · check-in free text available
2022-04-07
Survey response — day 0, dose 4
MedDRA: Cough — Feeling: Fair · Site: Pain

Free text: Cough

MedDRA releases: 2024-11 · check-in free text available
2022-04-08
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Itching · Muscle or body aches

Adult check-in
2022-04-09
Survey response — days 1–6 daily, dose 4
MedDRA: Injection site pain — Feeling: Good

Free text: Mild pain at the injection site.

MedDRA releases: 2024-11 · check-in free text available
2022-04-10
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-04-11
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · None

Adult check-in
2022-04-12
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-04-13
Survey response — days 1–6 daily, dose 4
MedDRA: Cough — Feeling: Good

Free text: A unusual cough that appeared on the second after the injection.

MedDRA releases: 2024-11 · check-in free text available
2022-04-14
Survey response — day 7, dose 4
MedDRA: Pain in extremity — Feeling: Good

Free text: Arm pain is better

MedDRA releases: 2024-11 · check-in free text available
2022-04-21
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-28
Survey response — day 21, dose 4
MedDRA: Cough, Diarrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Cough & diarrhea

MedDRA releases: 2024-11 · check-in free text available
2022-05-05
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-12
Survey response — day 35, dose 4
MedDRA: Arthralgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Joint pain ankles & knees.

MedDRA releases: 2024-11 · check-in free text available
2022-05-19
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-07-07
Survey response — 3 months, dose 4
MedDRA: Injection site pain — Feeling: Fair

Free text: Steady mild pain at the injection site.

MedDRA releases: 2024-11 · check-in free text available
2022-10-06
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2023-04-07
Survey response — 12 months, dose 4
MedDRA: Cough, Oropharyngeal pain, Productive cough — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-04-07
Report sent to call center — 12 months, 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)
2023-04-11
Call 1 — Left Voicemail
2023-04-11
Call 1 — Left Voicemail
2023-04-11
Call 1 — Left Voicemail
2023-04-11
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-05	Moderna
2	2021-04-07	Moderna
3	2021-11-30	Moderna	No
4	2022-04-07	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-20	Unsuccessful
2021-03-26	Unsuccessful
2021-04-04	Unsuccessful
2023-04-07	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-07

Systemic reaction (other): The arm pain is barely noticeable!!

2021-03-08

Systemic reaction (other): The pain is barely noticeable I have to press my hand on the site to feel it!

Release 6 — day 14, dose 1

2021-03-20

Symptoms: Serious vomiting & diarrhea plus minor abdominal pain.

Healthcare visit (other): The hospital did make CV19 test & it was negative!

Release 6 — day 21, dose 1

2021-03-26

Symptoms: They discovered that my Gallbladder has a serious problem. Plus it is creating a lot of pain

Release 6 — day 28, dose 1

2021-04-04

Symptoms: It turns out I had a bad gallbladder. But that has been removed and things seem to be on an upswing.

Release 7 — days 1–6 daily, dose 2

2021-04-11

Systemic reaction (other): The pain is so mild if I dont think about it it is noticeable.

2021-04-13

Systemic reaction (other): I had my gallbladder out 2 weeks ago & food does not appeal much. This is different than the surgeon said. He said I could eat normally but not greasy food or caffeine. Is my lack of interest due to operation or vaccine?

Release 7 — day 7, dose 2

2021-04-15

Systemic reaction (other): Slight pain that is better today.

Release 7 — day 14, dose 2

2021-04-21

Symptoms: Abdominal pains and a feeling of malaise.

Release 11 — day 0, dose 4

2022-04-07

Systemic reaction (other): Cough

Release 11 — 12 months, dose 2

2022-04-07

Symptoms: Mild pain in my Rt shoulder. Additionally frequently coughing (This was not occurring prior to the injection). I cannot tell if it is related to the shot. I did not have a caugh prior to the shot. It started about 12 hours later.

Release 11 — days 1–6 daily, dose 4

2022-04-09

Systemic reaction (other): Mild pain at the injection site.

2022-04-13

Systemic reaction (other): A unusual cough that appeared on the second after the injection.

Release 11 — day 7, dose 4

2022-04-14

Systemic reaction (other): Arm pain is better

Release 11 — day 21, dose 4

2022-04-28

Symptoms: Cough & diarrhea

Release 11 — day 35, dose 4

2022-05-12

Symptoms: Joint pain ankles & knees.

Release 12 — 3 months, dose 4

2022-07-07

Symptoms: Steady mild pain at the injection site.

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	Emergency care	✓	✓	✓
HCVO	SARS-CoV-2 test negative	✓	✓	✓
SD	Abdominal pain	✓	✓	✓
SD	Arthralgia	·	·	✓
SD	Biliary colic	✓	✓	✓
SD	Cholecystectomy	✓	✓	✓
SD	Cough	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Gallbladder disorder	✓	✓	✓
SD	Injection site pain	·	·	✓
SD	Malaise	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Productive cough	·	·	✓
SD	Vomiting	✓	✓	✓
SRO	Cholecystectomy	✓	✓	✓
SRO	Cough	·	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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