YF5-11911-67136

3 vaccinations 6 coded responses 28 check-ins 6 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 331 / FL
Registered: 2021-01-13

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

2021-01-13
Registered in v-safe
2021-01-13
Dose 1 — Moderna
2021-01-13
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Chills

Adult check-in
2021-01-14
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site discomfort — Feeling: Good

Free text: Only a little discomfort at injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-05
Survey response — day 21, dose 1
MedDRA: Cough, Dyspnoea, Medical counselling, Pre-existing disease, Sneezing — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Coughing sneezing and some heavy breathing. Recent CT shows lung inflammation or infection. Status post lung cancer surgery in April 2020. Doing Telehealth visit with oncologist next Tuesday. · Healthcare visit (other): Phone call to insurance company nurse hotline

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-10
Dose 2 — Moderna
2021-02-10
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-03
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-17
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-12
Survey response — 3 months, dose 2
MedDRA: Epistaxis, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Bloody nose on and off. · Healthcare visit (other): Going next eeekbfor in person visit with ENT

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-16
Call 1 — Left Voicemail
2021-08-11
Survey response — 6 months, dose 2
MedDRA: Nasopharyngitis, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activities

Free text: Very bad cold, Im assuming. Lasted about 5 days. Did COVID test shortly after it started and it was negative.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-28
Dose 3 — Moderna
2021-11-27
Survey response — 3 months, dose 3
MedDRA: Cough, Fatigue, Headache — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Headache fatigue cough.

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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-11-30
Call successful
Not applicable - Accidental Reporting
2021-11-30
Call successful
Not applicable - Accidental Reporting
2021-11-30
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-02-26
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-08-28
Survey response — 12 months, dose 3
MedDRA: Dysgeusia, Fatigue, Mitral valve prolapse, Vision blurred — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Salty taste and some blurry vision. Hospital workup for suspected TIA. Tests negative. Recent cardiologist exam resulting in diagnosis of MVP. Tiredness most days.

MedDRA releases: 2024-11 · check-in free text available
2022-08-28
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-08-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-13	Moderna
2	2021-02-10	Moderna
3	2021-08-28	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-05	Successful 2021-11-30	Not applicable - Accidental Reporting
2021-05-12	Successful 2021-11-30	Not applicable - Accidental Reporting
2021-11-27	Successful 2021-11-30	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-08-28	Successful 2022-08-29	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-14

Systemic reaction (other): Only a little discomfort at injection site

Release 3 — day 21, dose 1

2021-02-05

Symptoms: Coughing sneezing and some heavy breathing. Recent CT shows lung inflammation or infection. Status post lung cancer surgery in April 2020. Doing Telehealth visit with oncologist next Tuesday.

Healthcare visit (other): Phone call to insurance company nurse hotline

Release 8 — 3 months, dose 2

2021-05-12

Symptoms: Bloody nose on and off.

Healthcare visit (other): Going next eeekbfor in person visit with ENT

Release 9 — 6 months, dose 2

2021-08-11

Symptoms: Very bad cold, Im assuming. Lasted about 5 days. Did COVID test shortly after it started and it was negative.

Release 10 — 3 months, dose 3

2021-11-27

Symptoms: Headache fatigue cough.

Release 12 — 12 months, dose 3

2022-08-28

Symptoms: Salty taste and some blurry vision. Hospital workup for suspected TIA. Tests negative. Recent cardiologist exam resulting in diagnosis of MVP. Tiredness most days.

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	Medical counselling	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Dysgeusia	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Epistaxis	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Mitral valve prolapse	·	·	✓
SD	Nasopharyngitis	✓	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	·	✓
SD	Sneezing	✓	✓	✓
SD	Vision blurred	·	·	✓
SRO	Injection site discomfort	✓	✓	✓

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