YKP-98508-60599

4 vaccinations 14 coded responses 44 check-ins 13 free-text entries 1 call case

Sex: Male
Age at first dose: 51-55
ZIP prefix: 117 / NY
Registered: 2021-01-12

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

Registered dependents

B39-23163-36428 Child or adolescent in my care · Female · 2022-08-05

Timeline

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

2021-01-12
Registered in v-safe
2021-01-12
Dose 1 — Moderna
2021-01-12
Survey response — day 0, dose 1
MedDRA: Dizziness — Feeling: Good

Free text: Some light headedness, mildly woozy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Survey response — days 1–6 daily, dose 1
MedDRA: Ear pain — Feeling: Good · Site: Pain, Swelling

Free text: Transient ipsilateral inner ear ache for 3-5 mins

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

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

Adult check-in
2021-01-20
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Survey response — day 14, dose 1
MedDRA: Headache — Feeling: Fair

Free text: Headache as if I had a cold this morning w/o any other cold symptoms. It went away in the afternoon.

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

Adult check-in
2021-02-09
Dose 2 — Moderna
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain — Feeling: Poor · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Earache and all of this was actually on 2/10-2/11, not today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

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 — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-02
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
2021-03-23
Survey response — day 42, dose 2
MedDRA: Feeling abnormal — Feeling: Good

Free text: Brain fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-10
Survey response — 6 months, dose 2
MedDRA: Cough, Rhinorrhoea — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Mild cough and runny nose

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-10
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-17
Call 1 — Left Voicemail
2021-08-18
Call 2 — Left Voicemail
2021-10-28
Dose 3 — Moderna
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Ear pain, Night sweats — Feeling: Fair · Site: Pain · Chills

Free text: Ear ache (mild, short lived) sweaty last night and mild cough.

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — Feeling: Good

Free text: Mild cough yesterday.

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Survey response — day 7, dose 3
MedDRA: Cough, Rhinorrhoea — Feeling: Good

Free text: Coughing on and off since last vaccination and runny nose. Unsure if it is related or not. Mild

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Survey response — day 14, dose 3
MedDRA: Myalgia, Sleep disorder — Feeling: Fair · Be unable to do your normal daily activities

Free text: Lower extremity myalgia and difficulty sleeping bcs of it.

MedDRA releases: 2024-11 · check-in free text available
2021-11-21
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-25
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-02
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-11
Survey response — day 42, dose 3
MedDRA: Cough, Rhinorrhoea — Feeling: Good

Free text: Cough, runny nose

MedDRA releases: 2024-11 · check-in free text available
2022-01-27
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-28
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-07-15
Dose 4 — Pfizer-BioNTech
2022-07-15
Health check-in — day 0, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-07-16
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-07-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-07-19
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-07-20
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-07-22
Health check-in — day 7, dose 4
Feeling: Good · Headache

Adult check-in
2022-07-30
Survey response — day 14, dose 4
MedDRA: Aphasia, Brain fog — Feeling: Good

Free text: Brain fog and word retrieval issues.

MedDRA releases: 2024-11 · check-in free text available
2022-08-05
Survey response — day 21, dose 4
MedDRA: Aphasia, Brain fog — Feeling: Fair

Free text: Brain fog and word retrieval issues.

MedDRA releases: 2024-11 · check-in free text available
2022-08-12
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-08-19
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-08-26
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-10-14
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-01-15
Survey response — 6 months, dose 4
MedDRA: COVID-19 — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-12	Moderna
2	2021-02-09	Moderna
3	2021-10-28	Moderna	No
4	2022-07-15	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-08-10	Unsuccessful

Free text

Release 1 — day 0, dose 1

2021-01-12

Systemic reaction (other): Some light headedness, mildly woozy.

Release 1 — days 1–6 daily, dose 1

2021-01-13

Systemic reaction (other): Transient ipsilateral inner ear ache for 3-5 mins

Release 2 — day 14, dose 1

2021-01-26

Symptoms: Headache as if I had a cold this morning w/o any other cold symptoms. It went away in the afternoon.

Release 4 — days 1–6 daily, dose 2

2021-02-13

Systemic reaction (other): Earache and all of this was actually on 2/10-2/11, not today.

Release 6 — day 42, dose 2

2021-03-23

Symptoms: Brain fog

Release 9 — 6 months, dose 2

2021-08-10

Symptoms: Mild cough and runny nose

Release 10 — days 1–6 daily, dose 3

2021-10-30

Systemic reaction (other): Ear ache (mild, short lived) sweaty last night and mild cough.

2021-11-02

Systemic reaction (other): Mild cough yesterday.

Release 10 — day 7, dose 3

2021-11-04

Systemic reaction (other): Coughing on and off since last vaccination and runny nose. Unsure if it is related or not. Mild

Release 10 — day 14, dose 3

2021-11-13

Symptoms: Lower extremity myalgia and difficulty sleeping bcs of it.

Release 10 — day 42, dose 3

2021-12-11

Symptoms: Cough, runny nose

Release 12 — day 14, dose 4

2022-07-30

Symptoms: Brain fog and word retrieval issues.

Release 12 — day 21, dose 4

2022-08-05

Symptoms: Brain fog and word retrieval issues.

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	Aphasia	·	·	✓
SD	Brain fog	·	·	✓
SD	Cough	✓	·	✓
SD	COVID-19	·	·	✓
SD	Feeling abnormal	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Myalgia	·	·	✓
SD	Rhinorrhoea	✓	·	✓
SD	Sleep disorder	·	·	✓
SRO	Cough	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Night sweats	·	·	✓
SRO	Rhinorrhoea	·	·	✓

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