YAT-19172-86633

4 vaccinations 5 coded responses 19 check-ins 4 free-text entries 3 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 052 / VT
Registered: 2021-03-17

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

2021-03-16
Dose 1 — Moderna
2021-03-17
Registered in v-safe
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-22
Survey response — days 1–6 daily, dose 1
MedDRA: Lymphadenopathy — Feeling: Good

Free text: I am embarrassed. Apparently I overlooked an ipsilateral axillary lymphadenopathy. I noted it today, but it may have been there for a few days. It is not uncomfortable, not does it restrict my arm motility or function. Sorry for my lack of attention I know the data you collect are important. Thanks for all you do!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Survey response — day 7, dose 1
MedDRA: Lymphadenopathy — Feeling: Good

Free text: Mild ipsilateral axillary lymphadenopathy remains. Not bothersome.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-13
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-15
Dose 2 — Moderna
2021-04-22
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-29
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-13
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-20
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-27
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-11-04
Dose 3 — Moderna
2022-05-12
Dose 4 — Moderna
2022-06-08
Survey response — day 21, dose 4
MedDRA: Autoimmune disorder, Malaise, Office visit, Oral disorder, Radial pulse abnormal, Tongue erythema, Ventricular extrasystoles — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Felt ill 15 days after 4th vaccine. Checked radial pulse and found multiple PVCs occurring. Stress test is pending electrolytes and EKG normal. Today routine dental hygiene visit, red lingual lesions, presumed to be auto immune related, were noted. · Healthcare visit (other): Doctor's office visit.

MedDRA releases: 2024-11 · check-in free text available
2022-06-08
Report sent to call center — day 21, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-06-09
Call 1 — Requested Callback
2022-06-10
Callback requested for
09:00AM ET
2022-06-10
Call successful
Does not wish to fill out VAERS report
2022-11-10
Survey response — 6 months, dose 4
MedDRA: Arrhythmia, Extrasystoles, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Intermittent trigeminy and related cardiac arrhythmia, first noted two weeks after my second Moderns booster in early May, persist. EKG, Echocardiogram/stress test and blood work to R/O M.I., electrolytes as well as CRP were all normal. · Healthcare visit (other): See above narrative.

MedDRA releases: 2024-11 · check-in free text available
2022-11-10
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-11
Call 1 — Requested Callback
2022-11-11
Callback requested for
02:30PM ET
2022-11-11
Call successful
Does not wish to fill out VAERS report
2023-05-12
Survey response — 12 months, dose 4
MedDRA: Arrhythmia, Emergency care, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-05-12
Report sent to call center — 12 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2023-05-15
Call 1 — Could Not Reach Participant
2023-05-18
Call 2 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-16	Moderna
2	2021-04-15	Moderna
3	2021-11-04	Moderna	No
4	2022-05-12	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-06-08	Successful 2022-06-10	Does not wish to fill out VAERS report
2022-11-10	Successful 2022-11-11	Does not wish to fill out VAERS report
2023-05-12	Unsuccessful

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-22

Systemic reaction (other): I am embarrassed. Apparently I overlooked an ipsilateral axillary lymphadenopathy. I noted it today, but it may have been there for a few days. It is not uncomfortable, not does it restrict my arm motility or function. Sorry for my lack of attention I know the data you collect are important. Thanks for all you do!

Release 6 — day 7, dose 1

2021-03-23

Systemic reaction (other): Mild ipsilateral axillary lymphadenopathy remains. Not bothersome.

Release 11 — day 21, dose 4

2022-06-08

Symptoms: Felt ill 15 days after 4th vaccine. Checked radial pulse and found multiple PVCs occurring. Stress test is pending electrolytes and EKG normal. Today routine dental hygiene visit, red lingual lesions, presumed to be auto immune related, were noted. cut off by CDC

Healthcare visit (other): Doctor's office visit.

Release 12 — 6 months, dose 4

2022-11-10

Symptoms: Intermittent trigeminy and related cardiac arrhythmia, first noted two weeks after my second Moderns booster in early May, persist. EKG, Echocardiogram/stress test and blood work to R/O M.I., electrolytes as well as CRP were all normal.

Healthcare visit (other): See above narrative.

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	Office visit	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Arrhythmia	·	·	✓
SD	Autoimmune disorder	·	·	✓
SD	Extrasystoles	·	·	✓
SD	Malaise	·	·	✓
SD	Office visit	·	·	✓
SD	Oral disorder	·	·	✓
SD	Radial pulse abnormal	·	·	✓
SD	Tongue erythema	·	·	✓
SD	Ventricular extrasystoles	·	·	✓
SRO	Lymphadenopathy	✓	✓	✓

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