YS3-10225-88203

1 vaccination 10 coded responses 14 check-ins 10 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 491 / MI
Registered: 2021-02-03

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

2021-02-02
Dose 1 — Moderna
2021-02-03
Registered in v-safe
2021-02-03
Survey response — days 1–6 daily, dose 1
MedDRA: Respiratory disorder, Tremor — Feeling: Poor · Fever · Be unable to do your normal daily activities

Free text: Almost went into respiratory failure. Arms & legs shaking real hard. HB

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Fair · Site: Redness · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Breathing much better than yesterday when he almost went into respiratory failure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea, Headache — Feeling: Poor · Site: Redness · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Still having extra hard time breathing, and 1st headache in 50 yrs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — days 1–6 daily, dose 1
MedDRA: Chronic obstructive pulmonary disease, Condition aggravated, Pre-existing disease — Feeling: Fair · Site: Redness · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Breathing better... Had been very tough since vaccine. Does have severe COPD

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite, Dyspnoea — Feeling: Poor · Site: Redness · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Still extra short of breath, poor appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — day 7, dose 1
MedDRA: Dyspnoea — Feeling: Poor · Site: Pain, Redness · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Still has breathing issues worse than usual

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — day 14, dose 1
Feeling: Poor

Adult check-in
2021-02-23
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-03-02
Survey response — day 28, dose 1
MedDRA: Adverse reaction, Asthenia, Decreased appetite, Dyspnoea, Medical counselling — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Still getting extremely short of breath even just eating. Now has House Calls vs own dr because still to weak to go to Dr. They have ordered oxygen for home...never had before this adverse reaction. Appetite is a little better, but eats very small. · Healthcare visit (other): Nurse came to house, did teleconference with provider. Did

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Report sent to call center — day 28, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-09
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-03-16
Survey response — day 42, dose 1
MedDRA: Asthenia, Decreased appetite, Dyspnoea, Medical counselling — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Continue s to have extra hard time breathing...still weak..low appetite. Starting on antibiotics & NAC in nebulizer. · Healthcare visit (other): Home health, now they referred him to pulmonologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Report sent to call center — day 42, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-06
Survey response — 3 months, dose 1
MedDRA: Dyspnoea, Dysuria, Fluid retention, Medical counselling, Respiratory disorder, Urinary tract obstruction — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Severe breathing issues, water retention, and as of today...not able to urinate · Healthcare visit (other): House Calls since day after Moderna vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Report sent to call center — 3 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-03
Survey response — 6 months, dose 1
MedDRA: Asthenia, Death, Fluid retention, Medical counselling — Feeling: Poor · Be unable to work or attend school, 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, Emergency room or emergency department visit

Free text: Symptoms: Retaining water...more weakness..more spells that started the night Tommy had his vaccine. Tommy is deceased as of 07/13/21 · Healthcare visit (other): Home Health Care

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-03
Report sent to call center — 6 months, dose 1
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)
2021-08-05
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-02-02
Health check-in — 12 months, dose 1
Feeling: Poor

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-02	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-02	Successful	Reported to VAERS voluntarily prior to GDIT contact
2021-03-16	Successful	Reported to VAERS voluntarily prior to GDIT contact
2021-05-06	Successful	Reported to VAERS voluntarily prior to GDIT contact
2021-08-03	Successful 2021-08-05	Reported to VAERS voluntarily prior to GDIT contact

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-03

Systemic reaction (other): Almost went into respiratory failure. Arms & legs shaking real hard. HB

2021-02-04

Systemic reaction (other): Breathing much better than yesterday when he almost went into respiratory failure

2021-02-05

Systemic reaction (other): Still having extra hard time breathing, and 1st headache in 50 yrs

2021-02-07

Systemic reaction (other): Breathing better... Had been very tough since vaccine. Does have severe COPD

2021-02-08

Systemic reaction (other): Still extra short of breath, poor appetite

Release 3 — day 7, dose 1

2021-02-09

Systemic reaction (other): Still has breathing issues worse than usual

Release 4 — day 28, dose 1

2021-03-02

Symptoms: Still getting extremely short of breath even just eating. Now has House Calls vs own dr because still to weak to go to Dr. They have ordered oxygen for home...never had before this adverse reaction. Appetite is a little better, but eats very small. cut off by CDC

Healthcare visit (other): Nurse came to house, did teleconference with provider. Did

Release 5 — day 42, dose 1

2021-03-16

Symptoms: Continue s to have extra hard time breathing...still weak..low appetite. Starting on antibiotics & NAC in nebulizer.

Healthcare visit (other): Home health, now they referred him to pulmonologist

Release 8 — 3 months, dose 1

2021-05-06

Symptoms: Severe breathing issues, water retention, and as of today...not able to urinate

Healthcare visit (other): House Calls since day after Moderna vaccine

Release 9 — 6 months, dose 1

Reports this person's death

2021-08-03

Symptoms: Retaining water...more weakness..more spells that started the night Tommy had his vaccine. Tommy is deceased as of 07/13/21

Healthcare visit (other): Home Health Care

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	Medical counselling	✓	✓	✓
SD	Adverse reaction	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Death	✓	·	✓
SD	Decreased appetite	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Dysuria	✓	·	✓
SD	Fluid retention	✓	·	✓
SD	Medical counselling	✓	✓	✓
SD	Respiratory disorder	✓	·	✓
SD	Urinary tract obstruction	○	✓	○
SRO	Chronic obstructive pulmonary disease	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Respiratory disorder	✓	✓	✓
SRO	Tremor	✓	✓	✓

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