YRL-28558-18695

2 vaccinations 7 coded responses 15 check-ins 7 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 217 / MD
Registered: 2021-02-12

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

2021-02-12
Registered in v-safe
2021-02-12
Dose 1 — Moderna
2021-02-12
Survey response — day 0, dose 1
MedDRA: Pre-existing disease — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: I'm treaded for (b)(6)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: I also have an autoimmune neuromuscular disorder so that must be considered

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-27
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-06
Survey response — day 21, dose 1
MedDRA: Condition aggravated, General physical health deterioration, Mobility decreased, Pre-existing disease — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: For 2 weeks about 5 days post shot my general health declined badly. I have an autoimmune neuromuscular disorder and my mobility was severely compromised. I am now starting to feel better. #2 is on the 12th. I have messaged (b)(6).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Dose 2 — Moderna
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction, Pre-existing disease — Feeling: Good · Muscle or body aches · Be unable to do your normal daily activities

Free text: I did react, I have SPS an autoimmune neuromuscular disorder

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-09
Survey response — day 28, dose 2
MedDRA: Asthenia, Coordination abnormal, Fatigue, Gait disturbance, Pain, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Very weak, sore, tired but that is probably from my disorder. I did have an initial loss of coordination after both shots with inability to walk straight.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-13
Survey response — 3 months, dose 2
MedDRA: Chest pain, Dyspnoea, Fatigue, Hyperhidrosis, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Sever chest pains, heavy sweating, shortness of breath and fatigue. Saw my PCP who referred me to cardiologist. I will see a vascular but what happened is unexplained. I walked up 2 flights of stairs.EKG, echocardiogram, and a nuclear stress test(?) · Healthcare visit (other): Visit the next day to PCP and Cardiologist two days later.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-13
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-23
Call successful
Does not wish to fill out VAERS report
2021-09-10
Survey response — 6 months, dose 2
MedDRA: Chest pain, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Severe chest pain from an unknown reason. EKG was ok, Echo ok, and cat scan appear normal. Sudden onset and lasted a couple hrs. · Healthcare visit (other): At PCP and cardiologist

MedDRA releases: 2024-11 · check-in free text available
2021-09-10
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

1 call case(s)
2021-09-15
Call 1 — Left Voicemail
2022-03-12
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-12	Moderna
2	2021-03-12	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-06-13	Successful 2021-06-23	Does not wish to fill out VAERS report
2021-09-10	Unsuccessful

Free text

Release 4 — day 0, dose 1

2021-02-12

Systemic reaction (other): I'm treaded for (b)(6)

redacted (b)(6)

Release 4 — days 1–6 daily, dose 1

2021-02-13

Systemic reaction (other): I also have an autoimmune neuromuscular disorder so that must be considered

Release 5 — day 21, dose 1

2021-03-06

Symptoms: For 2 weeks about 5 days post shot my general health declined badly. I have an autoimmune neuromuscular disorder and my mobility was severely compromised. I am now starting to feel better. #2 is on the 12th. I have messaged (b)(6).

redacted (b)(6)

Release 5 — days 1–6 daily, dose 2

2021-03-16

Systemic reaction (other): I did react, I have SPS an autoimmune neuromuscular disorder

Release 7 — day 28, dose 2

2021-04-09

Symptoms: Very weak, sore, tired but that is probably from my disorder. I did have an initial loss of coordination after both shots with inability to walk straight.

Release 9 — 3 months, dose 2

2021-06-13

Symptoms: Sever chest pains, heavy sweating, shortness of breath and fatigue. Saw my PCP who referred me to cardiologist. I will see a vascular but what happened is unexplained. I walked up 2 flights of stairs.EKG, echocardiogram, and a nuclear stress test(?) cut off by CDC

Healthcare visit (other): Visit the next day to PCP and Cardiologist two days later.

Release 9 — 6 months, dose 2

2021-09-10

Symptoms: Severe chest pain from an unknown reason. EKG was ok, Echo ok, and cat scan appear normal. Sudden onset and lasted a couple hrs.

Healthcare visit (other): At PCP and cardiologist

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	Asthenia	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Coordination abnormal	✓	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gait disturbance	✓	·	✓
SD	General physical health deterioration	✓	✓	✓
SD	Hyperhidrosis	✓	✓	✓
SD	Mobility decreased	✓	✓	✓
SD	Office visit	✓	✓	✓
SD	Pain	✓	·	✓
SD	Pre-existing disease	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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