YBE-13283-00395

2 vaccinations 9 coded responses 26 check-ins 9 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 981 / WA
Registered: 2021-01-26

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-25
Dose 1 — Moderna
2021-01-26
Registered in v-safe
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Abdominal pain

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Joint pains

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-01
Survey response — day 7, dose 1
MedDRA: Arthralgia, Pain, Pain in extremity, Pruritus — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Itchy, stinging ache right knee and thigh.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — day 14, dose 1
MedDRA: Arthralgia — Feeling: Good

Free text: Intermittent right shoulder ache.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-22
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-25
Dose 2 — Moderna
2021-02-25
Health check-in — day 0, dose 2
Feeling: Good · Muscle or body aches, Diarrhea, Abdominal pain

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea, Fatigue — Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Out of breath from fatigue and tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea, Fatigue — Feeling: Good · Site: Pain, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: I feel like tiredness and fatigue is associated with out of breath.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — day 7, dose 2
MedDRA: Dyspnoea — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Out of breath

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

Adult check-in
2021-03-18
Survey response — day 21, dose 2
MedDRA: Dyspnoea, Dyspnoea exertional, Fatigue — Feeling: Good · Be unable to do your normal daily activities

Free text: Mildly fatigued, labored breathing with mild exertion. Not sure if its connected to the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-01
Survey response — day 35, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities

Free text: Knees. Not related to the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-27
Survey response — 3 months, dose 2
MedDRA: Office visit, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Not vaccine related, partially blocked coronary vessels. · Healthcare visit (other): Several in office examinations

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-26
Survey response — 6 months, dose 2
MedDRA: Cardiac operation, Coronary artery bypass — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Heart operation, CABGx4

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-26
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-08-30
Call 1 — Left Voicemail
2022-02-25
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-25	Moderna
2	2021-02-25	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-05-27	Unsuccessful
2021-08-26	Unsuccessful

Free text

Release 3 — day 7, dose 1

2021-02-01

Systemic reaction (other): Itchy, stinging ache right knee and thigh.

Release 3 — day 14, dose 1

2021-02-08

Symptoms: Intermittent right shoulder ache.

Release 4 — days 1–6 daily, dose 2

2021-03-01

Systemic reaction (other): Out of breath from fatigue and tiredness

Release 5 — days 1–6 daily, dose 2

2021-03-03

Systemic reaction (other): I feel like tiredness and fatigue is associated with out of breath.

Release 5 — day 7, dose 2

2021-03-04

Systemic reaction (other): Out of breath

Release 5 — day 21, dose 2

2021-03-18

Symptoms: Mildly fatigued, labored breathing with mild exertion. Not sure if its connected to the vaccine.

Release 6 — day 35, dose 2

2021-04-01

Symptoms: Knees. Not related to the vaccine.

Release 8 — 3 months, dose 2

2021-05-27

Symptoms: Not vaccine related, partially blocked coronary vessels.

Healthcare visit (other): Several in office examinations

Release 9 — 6 months, dose 2

2021-08-26

Symptoms: Heart operation, CABGx4

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	Arthralgia	✓	✓	✓
SD	Cardiac operation	✓	·	✓
SD	Coronary artery bypass	✓	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Dyspnoea exertional	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Unevaluable event	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pruritus	✓	✓	✓

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