YNB-10262-65535

4 vaccinations 11 coded responses 27 check-ins 12 free-text entries 2 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 087 / NJ
Registered: 2021-02-16

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

2021-01-30
Dose 1 — Moderna
2021-02-16
Registered in v-safe
2021-02-16
Survey response — day 14, dose 1
MedDRA: Arthralgia, Injection site rash, Neck pain, Pain, Pain in extremity — Feeling: Fair

Free text: 5 inch rash around injection site. Appeared about 7 days after the first vaccine. Pain in arm moving to shoulder then neck area

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Survey response — day 21, dose 1
MedDRA: Arthralgia, Back pain, Pain in extremity — Feeling: Fair

Free text: Left shoulder pain on the side of the vaccine. Unusual sharp pain in forearm bone when I rest my arm on desk, almost like the edge of the bone in my forearm is shaved off. Pain is moderate to severe then moderates with massage. Some back pain too

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Dose 2 — Moderna
2021-02-27
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Swelling · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling · Fatigue or tiredness

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness · Fatigue or tiredness

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Itching · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-03-06
Survey response — day 7, dose 2
MedDRA: Pruritus — Feeling: Fair · Site: Itching · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Itching all over 7 days after 2nd vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Survey response — day 14, dose 2
MedDRA: Bone pain, Pain in extremity — Feeling: Fair

Free text: Sharp pain in left forearm. Started after 1st vaccine. When I lean my arm on a desk I get a bad pain in my forearm lower edge of the bone. Im guessing some nerve damage.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — day 21, dose 2
MedDRA: Neuralgia, Reaction to previous exposure to any vaccine, Vaccination site haemorrhage, Vaccination site ulcer — Feeling: Good

Free text: Red spot of blood on vaccine site second vaccine right arm. Looks like an open sore. On original first vaccine left arm still nerve pain in forearm thats severe when I lean on my arm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Survey response — day 28, dose 2
MedDRA: Pain in extremity — Feeling: Good

Free text: Pain in left forearm is still moderate. Along the edge of the bone.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-11
Survey response — day 42, dose 2
MedDRA: Heart rate increased — Feeling: Fair

Free text: I notice my resting heart rate is now from 6-8 bpm higher than prior to vaccine. Its actually noticeable and measured. From 69-70 to 76-78.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-27
Dose 3 — Moderna
2021-08-31
Survey response — 6 months, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Third COVID-19 booster vaccine today 8/31/2021.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-28
Health check-in — 3 months, dose 3
Feeling: Good

Free text: Some hair loss.

Adult check-in · check-in free text available
2022-02-25
Survey response — 6 months, dose 3
MedDRA: COVID-19, Fatigue — Feeling: Fair · Be unable to work or attend school

Free text: Still fatigue from catching Covid on January 2.

MedDRA releases: 2024-11 · check-in free text available
2022-04-04
Dose 4 — Moderna
2022-04-14
Health check-in — day 7, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-04-18
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-25
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-02
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-09
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-06
Survey response — 3 months, dose 4
MedDRA: Deafness, Ear pain, Office visit — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional

Free text: Symptoms: Ear pain and loss of hearing · Healthcare visit (other): ENT doctor visit and hearing test.

MedDRA releases: 2024-11 · check-in free text available
2022-07-06
Report sent to call center — 3 months, dose 4
Be unable to work or attend school · Get care from a doctor or other healthcare professional

1 call case(s)
2022-07-07
Call 1 — Left Voicemail
2022-10-03
Survey response — 6 months, dose 4
MedDRA: Ear infection, Ligament pain, Office visit, Unevaluable event — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Ear infections and ligament problems. Right knee issues with no known cause. · Healthcare visit (other): Specialist dr visits

MedDRA releases: 2024-11 · check-in free text available
2022-10-03
Report sent to call center — 6 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2022-10-04
Call 2 — Left Voicemail
2022-10-04
Call 1 — Left Voicemail
2023-04-04
Health check-in — 12 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-30	Moderna
2	2021-02-27	Moderna
3	2021-08-27	Moderna	No
4	2022-04-04	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-07-06	Unsuccessful
2022-10-03	Unsuccessful

Free text

Release 4 — day 14, dose 1

2021-02-16

Symptoms: 5 inch rash around injection site. Appeared about 7 days after the first vaccine. Pain in arm moving to shoulder then neck area

Release 4 — day 21, dose 1

2021-02-20

Symptoms: Left shoulder pain on the side of the vaccine. Unusual sharp pain in forearm bone when I rest my arm on desk, almost like the edge of the bone in my forearm is shaved off. Pain is moderate to severe then moderates with massage. Some back pain too cut off by CDC

Release 5 — day 7, dose 2

2021-03-06

Systemic reaction (other): Itching all over 7 days after 2nd vaccine

Release 5 — day 14, dose 2

2021-03-13

Symptoms: Sharp pain in left forearm. Started after 1st vaccine. When I lean my arm on a desk I get a bad pain in my forearm lower edge of the bone. Im guessing some nerve damage.

Release 6 — day 21, dose 2

2021-03-20

Symptoms: Red spot of blood on vaccine site second vaccine right arm. Looks like an open sore. On original first vaccine left arm still nerve pain in forearm thats severe when I lean on my arm.

Release 6 — day 28, dose 2

2021-03-27

Symptoms: Pain in left forearm is still moderate. Along the edge of the bone.

Release 7 — day 42, dose 2

2021-04-11

Symptoms: I notice my resting heart rate is now from 6-8 bpm higher than prior to vaccine. Its actually noticeable and measured. From 69-70 to 76-78.

Release 9 — 6 months, dose 2

2021-08-31

Symptoms: Third COVID-19 booster vaccine today 8/31/2021.

Release 11 — 6 months, dose 3

2022-02-25

Symptoms: Still fatigue from catching Covid on January 2.

Release 12 — 3 months, dose 3

2021-11-28

Symptoms: Some hair loss.

Release 12 — 3 months, dose 4

2022-07-06

Symptoms: Ear pain and loss of hearing

Healthcare visit (other): ENT doctor visit and hearing test.

Release 12 — 6 months, dose 4

2022-10-03

Symptoms: Ear infections and ligament problems. Right knee issues with no known cause.

Healthcare visit (other): Specialist dr visits

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	Arthralgia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Bone pain	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Deafness	·	·	✓
SD	Ear infection	·	·	✓
SD	Ear pain	·	·	✓
SD	Fatigue	·	·	✓
SD	Heart rate increased	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Ligament pain	·	·	✓
SD	Neck pain	✓	✓	✓
SD	Neuralgia	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Reaction to previous exposure to any vaccine	✓	✓	✓
SD	Unevaluable event	✓	·	✓
SD	Vaccination site haemorrhage	✓	✓	✓
SD	Vaccination site ulcer	✓	✓	✓
SRO	Pruritus	✓	✓	✓

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