YV5-41259-45208

4 vaccinations 8 coded responses 41 check-ins 7 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 802 / CO
Registered: 2021-02-06

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

2021-02-06
Registered in v-safe
2021-02-06
Dose 1 — Moderna
2021-02-06
Survey response — day 0, dose 1
MedDRA: Unevaluable event — Feeling: Good

Free text: I have bitten the inside of my lower lip 5-times. lol

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-06
Dose 2 — Moderna
2021-03-06
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain — Feeling: Good

Free text: Soreness at injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site bruising — Feeling: Fair · Muscle or body aches

Free text: Injection site still feels like a healing bruise.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-03
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-17
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-05
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-09-04
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-17
Dose 3 — Moderna
2021-12-10
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-22
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-29
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-02-16
Survey response — 3 months, dose 3
MedDRA: SARS-CoV-2 test positive — Feeling: Good · Be unable to do your normal daily activities

Free text: Tested positive for Covid-19.

MedDRA releases: 2024-11 · check-in free text available
2022-04-18
Dose 4 — Moderna
2022-04-22
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Muscle or body aches

Adult check-in
2022-04-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-04-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-25
Survey response — day 7, dose 4
MedDRA: Depression — Feeling: Fair · Fatigue or tiredness

Free text: Slight increased depression

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Survey response — day 14, dose 4
MedDRA: Cough, Oropharyngeal pain — Feeling: Poor

Free text: Feels like I am getting a sore throat and cough. I have a friend who has the same but worse. He began symptoms 3 days ago. I began my symptoms last night.

MedDRA releases: 2024-11 · check-in free text available
2022-05-09
Survey response — day 21, dose 4
MedDRA: Influenza, Unevaluable event — 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

Free text: Symptoms: I had the type A flu. I am almost completely recovered now; only about 2 more days for completely being over it. · Healthcare visit (other): Prescription for Tamiflu 5-days.

MedDRA releases: 2024-11 · check-in free text available
2022-05-09
Report sent to call center — day 21, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-05-10
Call 1 — Left Voicemail
2022-05-14
Call 2 — Requested Callback
2022-05-16
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-16
Call 3 — Left Voicemail
2022-05-20
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-23
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-30
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-21
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-04-18
Survey response — 12 months, dose 4
MedDRA: Neoplasm malignant — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-18
Report sent to call center — 12 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-19
Call successful
Does not wish to fill out VAERS report
no date
Callback requested for
05:00PM ET

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-06	Moderna
2	2021-03-06	Moderna
3	2021-11-17	Moderna	No
4	2022-04-18	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-09	Successful 2022-05-20	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-18	Successful 2023-04-19	Does not wish to fill out VAERS report

Free text

Release 3 — day 0, dose 1

2021-02-06

Systemic reaction (other): I have bitten the inside of my lower lip 5-times. lol

Release 5 — days 1–6 daily, dose 2

2021-03-08

Systemic reaction (other): Soreness at injection site.

2021-03-09

Systemic reaction (other): Injection site still feels like a healing bruise.

Release 11 — 3 months, dose 3

2022-02-16

Symptoms: Tested positive for Covid-19.

Release 11 — day 7, dose 4

2022-04-25

Systemic reaction (other): Slight increased depression

Release 11 — day 14, dose 4

2022-05-02

Symptoms: Feels like I am getting a sore throat and cough. I have a friend who has the same but worse. He began symptoms 3 days ago. I began my symptoms last night.

Release 11 — day 21, dose 4

2022-05-09

Symptoms: I had the type A flu. I am almost completely recovered now; only about 2 more days for completely being over it.

Healthcare visit (other): Prescription for Tamiflu 5-days.

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	Unevaluable event	·	·	✓
SD	Cough	·	·	✓
SD	Influenza	·	·	✓
SD	Neoplasm malignant	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SRO	Depression	·	·	✓
SRO	Injection site bruising	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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