YDS-19694-23369

4 vaccinations 5 coded responses 25 check-ins 4 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 272 / NC
Registered: 2021-02-14

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-13
Dose 1 — Moderna
2021-02-14
Registered in v-safe
2021-02-14
Survey response — days 1–6 daily, dose 1
MedDRA: Pain, Pre-existing disease, Rheumatoid arthritis — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Those body aches and pain was partly due to Rheumatoid Arthritis.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Joint pains, Nausea

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Nausea

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-20
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-27
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-13
Dose 2 — Moderna
2021-03-13
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Joint pains, Muscle or body aches

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Joint pains, Muscle or body aches

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · Muscle or body aches

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · Joint pains

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · None

Adult check-in
2021-03-20
Health check-in — day 7, dose 2
Feeling: Good · Site: Swelling · None

Adult check-in
2021-03-27
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-03
Survey response — day 21, dose 2
MedDRA: Hospitalisation, Magnetic resonance imaging abnormal, Nodule, Office visit, Rotator cuff syndrome — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: They have nothing to do with covid, found out that i have 3 nodules on my thyrod gland, waiting for the byopsc report. Also had an Mri on my right shoulder, was determined that i have a tourn roto cuff. (Spellchecker needed) Other that that im fine!. · Healthcare visit (other): Mri was dine at the hospital and the byopisc was dine in the doctor' exam room.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-17
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-24
Survey response — day 42, dose 2
MedDRA: Rotator cuff syndrome, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Needing surgery on my right shoulder, torn rotorcuff. · Healthcare visit (other): Mri and a x-ray

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-12
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-06-14
Call 1 — Left Voicemail
2021-10-29
Dose 3 — Moderna
2022-04-14
Dose 4 — Moderna
2022-04-29
Survey response — day 14, dose 4
MedDRA: Rash — Feeling: Fair

Free text: Face is breaking out.

MedDRA releases: 2024-11 · check-in free text available
2022-05-21
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2023-04-14
Survey response — 12 months, dose 4
MedDRA: Colonoscopy abnormal, Haemorrhage, Haemorrhoid operation, Haemorrhoids, Large intestinal polypectomy, Post procedural complication, Procedural complication, Rectal fissure, Rectal haemorrhage, Surgical failure — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-13	Moderna
2	2021-03-13	Moderna
3	2021-10-29	Moderna	No
4	2022-04-14	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-03	Unsuccessful
2021-04-24	Unsuccessful

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-14

Systemic reaction (other): Those body aches and pain was partly due to Rheumatoid Arthritis.

Release 6 — day 21, dose 2

2021-04-03

Symptoms: They have nothing to do with covid, found out that i have 3 nodules on my thyrod gland, waiting for the byopsc report. Also had an Mri on my right shoulder, was determined that i have a tourn roto cuff. (Spellchecker needed) Other that that im fine!. cut off by CDC

Healthcare visit (other): Mri was dine at the hospital and the byopisc was dine in the doctor' exam room.

Release 7 — day 42, dose 2

2021-04-24

Symptoms: Needing surgery on my right shoulder, torn rotorcuff.

Healthcare visit (other): Mri and a x-ray

Release 11 — day 14, dose 4

2022-04-29

Symptoms: Face is breaking out.

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	Hospitalisation	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Colonoscopy abnormal	·	·	✓
SD	Haemorrhage	·	·	✓
SD	Haemorrhoid operation	·	·	✓
SD	Haemorrhoids	·	·	✓
SD	Large intestinal polypectomy	·	·	✓
SD	Magnetic resonance imaging abnormal	✓	✓	✓
SD	Nodule	✓	✓	✓
SD	Post procedural complication	·	·	✓
SD	Procedural complication	·	·	✓
SD	Rash	·	·	✓
SD	Rectal fissure	·	·	✓
SD	Rectal haemorrhage	·	·	✓
SD	Rotator cuff syndrome	✓	✓	✓
SD	Surgical failure	·	·	✓
SRO	Pain	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rheumatoid arthritis	✓	✓	✓

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