YM6-14011-87701

4 vaccinations 7 coded responses 49 check-ins 6 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 617 / IL
Registered: 2021-01-29

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

2021-01-29
Registered in v-safe
2021-01-29
Dose 1 — Moderna
2021-01-29
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-03
Survey response — days 1–6 daily, dose 1
MedDRA: Sinusitis — Feeling: Good · Headache

Free text: Due to sinus infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-05
Survey response — day 7, dose 1
MedDRA: Infection — Feeling: Fair · Headache, Fatigue or tiredness

Free text: I have some kind of infection. Have been seeing my doctor. Not related to vaccination.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-02-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-03
Dose 2 — Moderna
2021-03-03
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-04
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspepsia — Feeling: Fair · Site: Pain · Fatigue or tiredness, Abdominal pain

Free text: These symptoms are not related to the vaccination. Im dealing with some kind of a digestive issue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-31
Survey response — day 28, dose 2
MedDRA: Abdominal pain upper, Diarrhoea, Fatigue, Gastrointestinal infection, Myalgia, Nausea, SARS-CoV-2 test negative — 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: I contracted some kind of digestive infection. Stomach cramps, nausea, diarrhea, fatigue, achy muscles. Ive been to the doctor twice, had an IV and an injection. Covid test came back negative.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
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

1 call case(s)
2021-04-07
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-02
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-08
Dose 3 — Moderna
2021-10-27
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-10-29
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-05
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-12
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-07
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-03-18
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-08
Survey response — 6 months, dose 3
MedDRA: Cardiac operation, Surgery — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Hospitalization

Free text: Symptoms: Open heart surgery · Healthcare visit (other): Surgery

MedDRA releases: 2024-11 · check-in free text available
2022-04-08
Report sent to call center — 6 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 · Hospitalization · 1 call case(s)
2022-04-12
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-26
Dose 4 — Moderna
2022-04-26
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-04-27
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-04-28
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-29
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-01
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-02
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-03
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-10
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-31
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-07
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-26
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-25
Survey response — 6 months, dose 4
MedDRA: Bronchitis, Ear infection — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Bronchitis, ear infection

MedDRA releases: 2024-11 · check-in free text available
2022-10-25
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-26
Survey response — 12 months, dose 4
MedDRA: Cough, Fatigue, Pyrexia — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-04-26
Report sent to call center — 12 months, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2023-04-27
Call 1 — Left Voicemail
2023-04-27
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	2021-01-29	Moderna
2	2021-03-03	Moderna
3	2021-10-08	Moderna	No
4	2022-04-26	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-31	Successful 2022-03-18	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-08	Successful 2022-04-12	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-10-25	Successful 2022-10-26	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-26	Successful 2023-04-27	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-03

Systemic reaction (other): Due to sinus infection

Release 3 — day 7, dose 1

2021-02-05

Systemic reaction (other): I have some kind of infection. Have been seeing my doctor. Not related to vaccination.

Release 5 — days 1–6 daily, dose 2

2021-03-04

Systemic reaction (other): These symptoms are not related to the vaccination. Im dealing with some kind of a digestive issue.

Release 6 — day 28, dose 2

2021-03-31

Symptoms: I contracted some kind of digestive infection. Stomach cramps, nausea, diarrhea, fatigue, achy muscles. Ive been to the doctor twice, had an IV and an injection. Covid test came back negative.

Release 11 — 6 months, dose 3

2022-04-08

Symptoms: Open heart surgery

Healthcare visit (other): Surgery

Release 12 — 6 months, dose 4

2022-10-25

Symptoms: Bronchitis, ear 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	Surgery	·	·	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Bronchitis	·	·	✓
SD	Cardiac operation	·	·	✓
SD	Cough	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Ear infection	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Gastrointestinal infection	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SRO	Dyspepsia	✓	✓	✓
SRO	Infection	✓	✓	✓
SRO	Sinusitis	✓	✓	✓

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