YM9-26040-67984

4 vaccinations 6 coded responses 30 check-ins 6 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 852 / AZ
Registered: 2021-02-09

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

2021-02-09
Registered in v-safe
2021-02-09
Dose 1 — Moderna
2021-02-09
Health check-in — day 0, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-03-02
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-03-09
Dose 2 — Moderna
2021-03-09
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-13
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Clostridium difficile colitis, Clostridium difficile infection, Emergency care, Fall, Hospitalisation, Mobility decreased — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: I also got C-def again I was so weak I couldnt get up off the commode I finally slide off the commode seat after about 3 hours but just laid on the floor and couldnt move my friend called 911 to have them come check on me Im now in the hospital

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Get care from a doctor or other healthcare professional · Hospitalization

Adult check-in
2021-03-15
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-17
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-23
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-30
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-06
Survey response — day 28, dose 2
MedDRA: Diarrhoea — Feeling: Good

Free text: Getting diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — day 35, dose 2
MedDRA: Diarrhoea, Gait disturbance, Mobility decreased — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: I got a bad case of diarrhea 3 weeks ago and I still have it cant hardly walk again

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-20
Survey response — day 42, dose 2
MedDRA: Diarrhoea — Feeling: Fair

Free text: Still have diarrhea or loose stools

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-08
Survey response — 3 months, dose 2
MedDRA: Diarrhoea — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Diahrrea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-08
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-21
Call 1 — Left Voicemail
2021-09-07
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-28
Dose 3 — Pfizer-BioNTech
2022-03-09
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-09-19
Dose 4 — Pfizer-BioNTech
Co-administered: Flu
2022-09-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Chills, Fatigue or tiredness

Adult check-in
2022-09-27
Health check-in — day 7, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-10-03
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-10
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-17
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-24
Survey response — day 35, dose 4
MedDRA: Lymphadenopathy, Pulmonary mass — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I have bigger nodgels in my left lung and I have lymp node problems also I will need to get a biopsy done on the lymp nodes and the nodgels in my left lung

MedDRA releases: 2024-11 · check-in free text available
2022-10-24
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-27
Call 1 — Could Not Reach Participant
2022-10-27
Call 1 — Could Not Reach Participant
2022-10-27
Call 2 — Could Not Reach Participant
2022-10-27
Call 1 — Could Not Reach Participant
2022-10-31
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Moderna
2	2021-03-09	Moderna
3	2022-02-28	Pfizer-BioNTech	No
4	2022-09-19	Pfizer-BioNTech	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-03-15	Unsuccessful
2021-04-13	Unsuccessful
2021-06-08	Unsuccessful
2022-10-24	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-13

Systemic reaction (other): I also got C-def again I was so weak I couldnt get up off the commode I finally slide off the commode seat after about 3 hours but just laid on the floor and couldnt move my friend called 911 to have them come check on me Im now in the hospital

Release 7 — day 28, dose 2

2021-04-06

Symptoms: Getting diarrhea

Release 7 — day 35, dose 2

2021-04-13

Symptoms: I got a bad case of diarrhea 3 weeks ago and I still have it cant hardly walk again

Release 7 — day 42, dose 2

2021-04-20

Symptoms: Still have diarrhea or loose stools

Release 8 — 3 months, dose 2

2021-06-08

Symptoms: Diahrrea

Release 12 — day 35, dose 4

2022-10-24

Symptoms: I have bigger nodgels in my left lung and I have lymp node problems also I will need to get a biopsy done on the lymp nodes and the nodgels in my left lung

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	Diarrhoea	✓	✓	✓
SD	Gait disturbance	✓	✓	✓
SD	Lymphadenopathy	·	·	✓
SD	Mobility decreased	✓	✓	✓
SD	Pulmonary mass	·	·	✓
SRO	Asthenia	✓	✓	✓
SRO	Clostridium difficile colitis	○	✓	○
SRO	Clostridium difficile infection	✓	·	✓
SRO	Emergency care	✓	·	✓
SRO	Fall	○	✓	○
SRO	Hospitalisation	✓	✓	✓
SRO	Mobility decreased	✓	·	✓

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