YBY-21942-04327

4 vaccinations 19 coded responses 42 check-ins 18 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 857 / AZ
Registered: 2021-02-10

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

2021-02-09
Dose 1 — Moderna
2021-02-10
Registered in v-safe
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Sinus pain — Feeling: Poor · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Sinus ache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Free text: The tiredness came and went a number of times

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · Fatigue or tiredness

Adult check-in
2021-02-13
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Nausea, Sinus disorder — Feeling: Fair · Site: Swelling · Chills, Fatigue or tiredness, Nausea

Free text: Early AM fine. Mid AM began to feel tired and slight nausea. Intermittent sinus discomfort.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-02-16
Survey response — day 7, dose 1
MedDRA: Fatigue — Feeling: Fair · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Fatigue resulted in needing to nap twice today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Survey response — day 14, dose 1
MedDRA: Exercise tolerance decreased — Feeling: Fair · Be unable to do your normal daily activities

Free text: I exercise approximately every second or third day. Since the immunization exercising has been significantly more tiring than before.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — day 21, dose 1
MedDRA: Fatigue — Feeling: Poor · Be unable to do your normal daily activities

Free text: Fatigue, needing more naps than prior to immunization. Daily exercises almost exhausting for two hours after.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-12
Dose 2 — Moderna
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Influenza — Feeling: Good

Free text: The day AFTER the shot I had symptoms of a very bad flu. These were totally gone the following day. All fine since.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-23
Survey response — day 42, dose 2
MedDRA: Asthenia — Feeling: Fair

Free text: This afternoon energy level went low, not my normal.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-13
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-09-10
Survey response — 6 months, dose 2
MedDRA: Adverse reaction — Feeling: Good

Free text: Minor odd symptoms on a random basis. None of these interfered with my normal activities but were not my normal. Because they were not effecting my activities, I did not note symptoms.

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Dose 3 — Moderna
2021-10-28
Survey response — day 0, dose 3
MedDRA: Somnolence — Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness

Free text: Took 2 naps today, not my normal

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Somnolence — Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Slept 9 hrs last night and 4 more before 1:00 PM today.

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue — Feeling: Good · Fatigue or tiredness

Free text: The tiredness is minimal but I will need a nap today.

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Health check-in — day 7, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-11-13
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-18
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-27
Survey response — day 28, dose 3
MedDRA: Somnolence — Feeling: Good · Be unable to do your normal daily activities

Free text: Every other day I find I need to nap in the afternoon.

MedDRA releases: 2024-11 · check-in free text available
2021-12-02
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-27
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-19
Dose 4 — Moderna
2022-04-28
Survey response — 6 months, dose 3
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: A reacting but intermittent fatigue.

MedDRA releases: 2024-11 · check-in free text available
2022-05-15
Survey response — day 21, dose 4
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Tired

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Survey response — day 28, dose 4
MedDRA: Office visit, Pain in jaw, Sinus pain, Toothache — Feeling: Fair · 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: Symptoms: Sinus pain, intermittent. Intermittent jaw and tooth pain. · Healthcare visit (other): Primary care physician and Periodantist

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Report sent to call center — day 28, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-18
Call 1 — Left Voicemail
2022-05-24
Survey response — day 35, dose 4
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue resulting in multiple daily naps

MedDRA releases: 2024-11 · check-in free text available
2022-05-24
Call 2 — Requested Callback
2022-05-25
Call successful
Participant prefers to complete VAERS report online
2022-05-31
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-07-20
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-10-20
Survey response — 6 months, dose 4
MedDRA: Chemotherapy, Hospitalisation, Neoplasm malignant, Radiotherapy, Surgery — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: Recently diagnosed with cancer in jaw and some surrounding tissue. Surgery 9/23, released from hospital 10/11. · Healthcare visit (other): Surgery. Radiation and chemo to come.

MedDRA releases: 2024-11 · check-in free text available
2022-10-20
Report sent to call center — 6 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-10-21
Call 1 — Left Voicemail
2023-04-25
Survey response — 12 months, dose 4
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Moderna
2	2021-03-12	Moderna
3	2021-10-28	Moderna	No
4	2022-04-19	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-17	Successful 2022-05-25	Participant prefers to complete VAERS report online
2022-10-20	Unsuccessful

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Sinus ache

2021-02-11

Systemic reaction (other): The tiredness came and went a number of times

2021-02-13

Systemic reaction (other): Early AM fine. Mid AM began to feel tired and slight nausea. Intermittent sinus discomfort.

Release 4 — day 7, dose 1

2021-02-16

Systemic reaction (other): Fatigue resulted in needing to nap twice today.

Release 4 — day 14, dose 1

2021-02-24

Symptoms: I exercise approximately every second or third day. Since the immunization exercising has been significantly more tiring than before.

Release 4 — day 21, dose 1

2021-03-02

Symptoms: Fatigue, needing more naps than prior to immunization. Daily exercises almost exhausting for two hours after.

Release 5 — days 1–6 daily, dose 2

2021-03-16

Systemic reaction (other): The day AFTER the shot I had symptoms of a very bad flu. These were totally gone the following day. All fine since.

Release 7 — day 42, dose 2

2021-04-23

Symptoms: This afternoon energy level went low, not my normal.

Release 9 — 6 months, dose 2

2021-09-10

Symptoms: Minor odd symptoms on a random basis. None of these interfered with my normal activities but were not my normal. Because they were not effecting my activities, I did not note symptoms.

Release 10 — day 0, dose 3

2021-10-28

Systemic reaction (other): Took 2 naps today, not my normal

Release 10 — days 1–6 daily, dose 3

2021-10-29

Systemic reaction (other): Slept 9 hrs last night and 4 more before 1:00 PM today.

2021-11-03

Systemic reaction (other): The tiredness is minimal but I will need a nap today.

Release 10 — day 28, dose 3

2021-11-27

Symptoms: Every other day I find I need to nap in the afternoon.

Release 11 — 6 months, dose 3

2022-04-28

Symptoms: A reacting but intermittent fatigue.

Release 11 — day 21, dose 4

2022-05-15

Symptoms: Tired

Release 11 — day 28, dose 4

2022-05-17

Symptoms: Sinus pain, intermittent. Intermittent jaw and tooth pain.

Healthcare visit (other): Primary care physician and Periodantist

Release 11 — day 35, dose 4

2022-05-24

Symptoms: Fatigue resulting in multiple daily naps

Release 12 — 6 months, dose 4

2022-10-20

Symptoms: Recently diagnosed with cancer in jaw and some surrounding tissue. Surgery 9/23, released from hospital 10/11.

Healthcare visit (other): Surgery. Radiation and chemo to come.

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	Chemotherapy	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Radiotherapy	·	·	✓
HCVO	Surgery	·	·	✓
SD	Adverse reaction	·	·	✓
SD	Asthenia	✓	✓	✓
SD	Exercise tolerance decreased	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Hospitalisation	·	·	✓
SD	Neoplasm malignant	·	·	✓
SD	Pain in jaw	·	·	✓
SD	Sinus pain	·	·	✓
SD	Somnolence	·	·	✓
SD	Surgery	·	·	✓
SD	Toothache	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Influenza	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Sinus disorder	✓	✓	✓
SRO	Sinus pain	✓	✓	✓
SRO	Somnolence	·	·	✓

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