YUC-20184-07508

3 vaccinations 9 coded responses 32 check-ins 9 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 325 / FL
Registered: 2021-01-05

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

2021-01-05
Registered in v-safe
2021-01-05
Dose 1 — Moderna
2021-01-05
Survey response — day 0, dose 1
MedDRA: Muscle tightness — Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Free text: Clinching my jaws

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-06
Survey response — days 1–6 daily, dose 1
MedDRA: Flushing, Hyperhidrosis, Paraesthesia, Pyrexia, Self-medication — Feeling: Good · Site: Pain · Fever

Free text: The 101.4 fever was sudden onset of flushing and sweating and burning up Tylenol and ibuprofen and a cold shower it fell to 98.4 in a hour and I felt fine the rest of the day

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-11
Survey response — days 1–6 daily, dose 1
MedDRA: Chills — Feeling: Good · Chills, Diarrhea

Free text: Chills come suddenly and after piling on the cover go away. Night mostly

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-12
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-02
Dose 2 — Moderna
2021-02-22
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-23
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-02
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-16
Survey response — day 42, dose 2
MedDRA: Oedema peripheral — Feeling: Fair

Free text: Pedal edema

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-29
Dose 3 — Moderna
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Gastrointestinal sounds abnormal — Feeling: Good · Site: Pain, Redness

Free text: Growling guts

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness · None

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-05
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-12
Survey response — day 14, dose 3
MedDRA: Conjunctivitis viral — Feeling: Good

Free text: Viral conjunctivitis. No idea if it's related to the vaccine but never had it before

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-03
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-10
Survey response — day 42, dose 3
MedDRA: Conjunctivitis, Dry eye, Vision blurred — Feeling: Good

Free text: My eyes are so dry. This started about 4 weeks ago with conjunctivitis and has persisted. I've never had this before. Vision blurs at time

MedDRA releases: 2024-11 · check-in free text available
2022-01-28
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-29
Survey response — 6 months, dose 3
MedDRA: Pulpitis dental, Tooth disorder, Tooth fracture, Tooth infection — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: It was dental and not likely Covid-19 related. It did require a course of penicillin and steroids for inflammation, but not at the same time, two weeks apart. (Cracked tooth with crown complicated by infection)

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-02
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-31
Survey response — 12 months, dose 3
MedDRA: Deafness neurosensory, Sudden hearing loss — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sudden idiopathic sensorineural hearing loss

MedDRA releases: 2024-11 · check-in free text available
2022-10-31
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-01
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	2021-01-05	Moderna
2	2021-02-02	Moderna
3	2021-10-29	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-04-29	Successful 2022-05-02	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-31	Successful 2022-11-01	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 1 — day 0, dose 1

2021-01-05

Systemic reaction (other): Clinching my jaws

Release 1 — days 1–6 daily, dose 1

2021-01-06

Systemic reaction (other): The 101.4 fever was sudden onset of flushing and sweating and burning up Tylenol and ibuprofen and a cold shower it fell to 98.4 in a hour and I felt fine the rest of the day

2021-01-11

Systemic reaction (other): Chills come suddenly and after piling on the cover go away. Night mostly

Release 5 — day 42, dose 2

2021-03-16

Symptoms: Pedal edema

Release 10 — days 1–6 daily, dose 3

2021-10-31

Systemic reaction (other): Growling guts

Release 10 — day 14, dose 3

2021-11-12

Symptoms: Viral conjunctivitis. No idea if it's related to the vaccine but never had it before

Release 10 — day 42, dose 3

2021-12-10

Symptoms: My eyes are so dry. This started about 4 weeks ago with conjunctivitis and has persisted. I've never had this before. Vision blurs at time

Release 11 — 6 months, dose 3

2022-04-29

Symptoms: It was dental and not likely Covid-19 related. It did require a course of penicillin and steroids for inflammation, but not at the same time, two weeks apart. (Cracked tooth with crown complicated by infection)

Release 12 — 12 months, dose 3

2022-10-31

Symptoms: Sudden idiopathic sensorineural hearing loss

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	Conjunctivitis	·	·	✓
SD	Conjunctivitis viral	·	·	✓
SD	Deafness neurosensory	·	·	✓
SD	Dry eye	·	·	✓
SD	Oedema peripheral	✓	✓	✓
SD	Pulpitis dental	·	·	✓
SD	Sudden hearing loss	·	·	✓
SD	Tooth disorder	·	·	✓
SD	Tooth fracture	·	·	✓
SD	Tooth infection	·	·	✓
SD	Vision blurred	·	·	✓
SRO	Chills	✓	✓	✓
SRO	Flushing	✓	✓	✓
SRO	Gastrointestinal sounds abnormal	·	·	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Muscle tightness	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Self-medication	✓	✓	✓

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