YLW-21895-17693

2 vaccinations 6 coded responses 26 check-ins 6 free-text entries 2 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 777 / TX
Registered: 2021-06-30

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

2021-06-30
Registered in v-safe
2021-06-30
Dose 1 — Moderna
2021-06-30
Health check-in — day 0, dose 1
Feeling: Good · Site: Swelling · None

Adult check-in
2021-07-01
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Diarrhea

Adult check-in
2021-07-02
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Diarrhea

Adult check-in
2021-07-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-07-04
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-07-05
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-07-06
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Headache, Diarrhea

Adult check-in
2021-07-07
Health check-in — day 7, dose 1
Feeling: Fair · Diarrhea

Adult check-in
2021-07-14
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-07-21
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-07-31
Survey response — day 28, dose 1
MedDRA: Asthenia, Dehydration, Diarrhoea, Dizziness, Heart rate irregular, Nervousness — Feeling: Poor · Be unable to do your normal daily activities

Free text: Diarrhea, dehydration, irregular heartbeats, nervousness, weakness, dizziness.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-04
Survey response — day 35, dose 1
MedDRA: Blood pressure increased, Diarrhoea, Dizziness, Headache, Heart rate irregular — Feeling: Fair

Free text: Higher blood pressure, diarrhea, headaches, dizziness & irregular heart rate.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-16
Health check-in — day 42, dose 1
Feeling: Fair

Adult check-in
2021-09-01
Dose 2 — Moderna
2021-09-01
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-09-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-09-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches

Adult check-in
2021-09-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Diarrhea

Adult check-in
2021-09-10
Health check-in — day 7, dose 2
Feeling: Fair · None

Adult check-in
2021-09-16
Survey response — day 14, dose 2
MedDRA: Fatigue, Headache, Myalgia, Pain, Rhinorrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Head aches, Runny nose, body and muscle aches and fatigue.

MedDRA releases: 2024-11 · check-in free text available
2021-09-22
Survey response — day 21, dose 2
MedDRA: Fatigue, Headache, Oropharyngeal pain, Rhinorrhoea — Feeling: Fair

Free text: Runny nose, headaches, sore throat & fatigue.

MedDRA releases: 2024-11 · check-in free text available
2021-09-29
Survey response — day 28, dose 2
MedDRA: Chills, Dizziness, Fatigue, Headache, Myalgia, Pyrexia, Rhinorrhoea — Feeling: Poor · 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

Free text: Sore muscles, runny nose, headaches, dizziness, chills, lite fever and fatigue.

MedDRA releases: 2024-11 · check-in free text available
2021-09-29
Report sent to call center — day 28, dose 2
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 · 1 call case(s)
2021-10-05
Call 1 — Left Voicemail
2021-10-05
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-07
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-10-14
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-12-01
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2022-03-02
Survey response — 6 months, dose 2
MedDRA: Chills, Fatigue, Headache, Musculoskeletal stiffness, Myalgia, Oropharyngeal pain, Rhinorrhoea — 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, Outpatient clinic or urgent care clinic visit

Free text: Runny nose, sore throat, chills, fatigue, headaches, muscle aches and stiffness.

MedDRA releases: 2024-11 · check-in free text available
2022-03-02
Report sent to call center — 6 months, dose 2
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 · 1 call case(s)
2022-03-12
Call 1 — Left Voicemail
2022-03-15
Call 2 — Requested Callback
2022-03-15
Callback requested for
01:30PM ET
2022-03-15
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-09-01
Health check-in — 12 months, dose 2
Feeling: Poor

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-06-30	Moderna	No
2	2021-09-01	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-29	Successful 2021-10-05	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-03-02	Successful 2022-03-15	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 9 — day 28, dose 1

2021-07-31

Symptoms: Diarrhea, dehydration, irregular heartbeats, nervousness, weakness, dizziness.

Release 9 — day 35, dose 1

2021-08-04

Symptoms: Higher blood pressure, diarrhea, headaches, dizziness & irregular heart rate.

Release 9 — day 14, dose 2

2021-09-16

Symptoms: Head aches, Runny nose, body and muscle aches and fatigue.

Release 9 — day 21, dose 2

2021-09-22

Symptoms: Runny nose, headaches, sore throat & fatigue.

Release 9 — day 28, dose 2

2021-09-29

Symptoms: Sore muscles, runny nose, headaches, dizziness, chills, lite fever and fatigue.

Release 11 — 6 months, dose 2

2022-03-02

Symptoms: Runny nose, sore throat, chills, fatigue, headaches, muscle aches and stiffness.

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	Asthenia	✓	·	✓
SD	Blood pressure increased	✓	·	✓
SD	Chills	·	·	✓
SD	Dehydration	✓	·	✓
SD	Diarrhoea	✓	·	✓
SD	Dizziness	✓	·	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	·	✓
SD	Heart rate irregular	✓	·	✓
SD	Musculoskeletal stiffness	·	·	✓
SD	Myalgia	·	·	✓
SD	Nervousness	✓	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rhinorrhoea	·	·	✓

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