YG7-87963-72378

3 vaccinations 6 coded responses 17 check-ins 6 free-text entries 1 call case

Sex: Male
Age at first dose: 56-60
ZIP prefix: 014 / MA
Registered: 2021-03-23

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

2021-03-02
Dose 1 — Moderna
2021-03-23
Registered in v-safe
2021-03-23
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-30
Dose 2 — Moderna
2021-03-30
Survey response — day 0, dose 2
MedDRA: Pruritus, Tension headache — Feeling: Good · Site: Itching

Free text: Sides of my face feel itchy like I am growing muttonchops sideburns. Scalp feels tight like it's shrinkwrapping to my head

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain, Injection site pain, Musculoskeletal chest pain, Painful respiration — Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Abdominal pain

Free text: The only reason I think I have felt some pain at the injection site is because I slept on that side last night so it started hurting in the middle of the night but it really has gone away for the most part. About 5 AM I felt pain just a little to the left of my sternum at the bottom of my ribs, especially if I took a deep breath. That lasted most of the day, but is subsiding I belive.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-04-04
Survey response — days 1–6 daily, dose 2
MedDRA: Blood glucose increased, Fatigue — Feeling: Poor · Joint pains, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Exhausted upon awakening. Went back to bed at noon for 3 1/2 hours. Can't get my blood sugar to come down. May have nothing to do with the vaccine but I can't figure out why I can't get it to lower. High this morning and has only dropped 10 points after insulin use and metformin.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Health check-in — day 7, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-13
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-20
Survey response — day 21, dose 2
MedDRA: Musculoskeletal chest pain, Painful respiration — Feeling: Fair

Free text: Some pain just below my left rib if I take a deep breath. Not intense, but I can feel it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-04
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-11
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-01
Survey response — 3 months, dose 2
MedDRA: Headache, Hypertension — Feeling: Fair

Free text: Headaches and high blood pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-07
Dose 3 — Moderna
Co-administered: Flu:Shingles
2022-03-31
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-06-09
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-12-09
Survey response — 12 months, dose 3
MedDRA: Cardiovascular symptom, Dyspnoea, Fatigue, Positive airway pressure therapy — 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: Shortness of breath quickly fatigued. Symptoms of congestive heart failure. But being tested and now on lasik and using Cpap which has caused improvement.

MedDRA releases: 2024-11 · check-in free text available
2022-12-09
Report sent to call center — 12 months, dose 3
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)
2022-12-14
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-02	Moderna
2	2021-03-30	Moderna
3	2021-12-07	Moderna	Flu:Shingles

Call center

Reported	Outcome	VAERS-related outcome
2022-12-09	Successful 2022-12-14	Participant prefers to complete VAERS report online

Free text

Release 6 — day 0, dose 2

2021-03-30

Systemic reaction (other): Sides of my face feel itchy like I am growing muttonchops sideburns. Scalp feels tight like it's shrinkwrapping to my head

Release 6 — days 1–6 daily, dose 2

2021-03-31

Systemic reaction (other): The only reason I think I have felt some pain at the injection site is because I slept on that side last night so it started hurting in the middle of the night but it really has gone away for the most part. About 5 AM I felt pain just a little to the left of my sternum at the bottom of my ribs, especially if I took a deep breath. That lasted most of the day, but is subsiding I belive.

2021-04-04

Systemic reaction (other): Exhausted upon awakening. Went back to bed at noon for 3 1/2 hours. Can't get my blood sugar to come down. May have nothing to do with the vaccine but I can't figure out why I can't get it to lower. High this morning and has only dropped 10 points after insulin use and metformin.

Release 7 — day 21, dose 2

2021-04-20

Symptoms: Some pain just below my left rib if I take a deep breath. Not intense, but I can feel it.

Release 9 — 3 months, dose 2

2021-07-01

Symptoms: Headaches and high blood pressure

Release 12 — 12 months, dose 3

2022-12-09

Symptoms: Shortness of breath quickly fatigued. Symptoms of congestive heart failure. But being tested and now on lasik and using Cpap which has caused improvement.

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
SD	Cardiovascular symptom	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	✓	✓
SD	Hypertension	✓	✓	✓
SD	Musculoskeletal chest pain	✓	✓	✓
SD	Painful respiration	✓	✓	✓
SD	Positive airway pressure therapy	·	·	✓
SRO	Blood glucose increased	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Musculoskeletal chest pain	✓	✓	✓
SRO	Painful respiration	·	·	✓
SRO	Pruritus	✓	✓	✓
SRO	Tension headache	✓	✓	✓

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