YHS-27181-50439

3 vaccinations 7 coded responses 21 check-ins 7 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 932 / CA
Registered: 2021-01-20

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

Timeline

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

2021-01-20
Registered in v-safe
2021-01-20
Dose 1 — Moderna
2021-01-20
Health check-in — day 0, dose 1
Feeling: Fair · None

Adult check-in
2021-01-21
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Joint pains, Muscle or body aches, Nausea, Vomiting · Be unable to do your normal daily activities

Adult check-in
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches, Nausea

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches, Nausea, Vomiting · Be unable to do your normal daily activities

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-01-27
Health check-in — day 7, dose 1
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-02-03
Survey response — day 14, dose 1
MedDRA: Emergency care, Heart rate irregular — Feeling: Fair · Be unable to do your normal daily activities

Free text: On 1/31/21, I went. Into THE ER due to irrectic irregular heartbeat. I have been put on Metoprolol Succ 25mg. I was told what cause was. I need to talk to my primary doc & my cardiologist which I am in the process of doing now. Cause may not be vaccn

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-17
Dose 2 — Moderna
2021-02-24
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness, Nausea, Vomiting · Be unable to do your normal daily activities

Adult check-in
2021-03-05
Survey response — day 14, dose 2
MedDRA: Nausea, Pre-existing disease, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Nausea and vomiting. but I do not know if it is from the vaccine or from the cancer that I have had for quite some time now.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — day 21, dose 2
MedDRA: Dizziness, Feeling drunk, Nausea, Office visit, Regurgitation — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Nauseousness, regurgitation, lightheadedness, dizziness, a sense of being drunk while standing. · Healthcare visit (other): A patient doctor visit with my oncologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Report sent to call center — day 21, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-17
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-24
Survey response — day 35, dose 2
MedDRA: Fatigue, Nausea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Nauseous, feel extremely tired.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-19
Survey response — 3 months, dose 2
MedDRA: Decreased appetite, Gastrointestinal inflammation, Nausea — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Nauseous, loss of appetite, inflammation of the small intestine, entritis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Report sent to call center — 3 months, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-18
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-09-09
Dose 3 — Moderna
2021-10-24
Survey response — day 42, dose 3
MedDRA: Dizziness, Emergency care, Hypotension, Immune system disorder, Loss of consciousness, Neoplasm malignant, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization

Free text: Light headiness, blacked out on 4th of Oct. 2021. Went to er. HYPOTENSION. I have Cancer. I'm old with low immune system with underline condition. I do not believe that the virious caused any of my medical issues.

MedDRA releases: 2024-11 · check-in free text available
2021-10-24
Report sent to call center — day 42, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-11-01
Call 1 — Could Not Reach Participant
2021-11-04
Call 2 — Could Not Reach Participant
2021-12-09
Survey response — 3 months, dose 3
MedDRA: Back pain, Diarrhoea, Emergency care, Nausea, Vomiting — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I'm in emergency right now for pain in my lower back. Throwing up, nauseated, diarrhea. May be an infection.

MedDRA releases: 2024-11 · check-in free text available
2021-12-09
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2021-12-13
Call 1 — Left Voicemail
2022-03-10
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-20	Moderna
2	2021-02-17	Moderna
3	2021-09-09	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-10	Unsuccessful
2021-05-19	Unsuccessful
2021-10-24	Unsuccessful
2021-12-09	Unsuccessful

Free text

Release 3 — day 14, dose 1

2021-02-03

Symptoms: On 1/31/21, I went. Into THE ER due to irrectic irregular heartbeat. I have been put on Metoprolol Succ 25mg. I was told what cause was. I need to talk to my primary doc & my cardiologist which I am in the process of doing now. Cause may not be vaccn cut off by CDC

Release 5 — day 14, dose 2

2021-03-05

Symptoms: Nausea and vomiting. but I do not know if it is from the vaccine or from the cancer that I have had for quite some time now.

Release 5 — day 21, dose 2

2021-03-10

Symptoms: Nauseousness, regurgitation, lightheadedness, dizziness, a sense of being drunk while standing.

Healthcare visit (other): A patient doctor visit with my oncologist.

Release 6 — day 35, dose 2

2021-03-24

Symptoms: Nauseous, feel extremely tired.

Release 8 — 3 months, dose 2

2021-05-19

Symptoms: Nauseous, loss of appetite, inflammation of the small intestine, entritis

Release 10 — day 42, dose 3

2021-10-24

Symptoms: Light headiness, blacked out on 4th of Oct. 2021. Went to er. HYPOTENSION. I have Cancer. I'm old with low immune system with underline condition. I do not believe that the virious caused any of my medical issues.

Release 10 — 3 months, dose 3

2021-12-09

Symptoms: I'm in emergency right now for pain in my lower back. Throwing up, nauseated, diarrhea. May be an infection.

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	Back pain	·	·	✓
SD	Decreased appetite	✓	✓	✓
SD	Diarrhoea	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Emergency care	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling drunk	✓	✓	✓
SD	Gastrointestinal inflammation	✓	✓	✓
SD	Heart rate irregular	✓	✓	✓
SD	Hypotension	·	·	✓
SD	Immune system disorder	·	·	✓
SD	Loss of consciousness	·	·	✓
SD	Nausea	✓	✓	✓
SD	Neoplasm malignant	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Regurgitation	✓	✓	✓
SD	Vomiting	✓	✓	✓

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