YXF-24985-95874

2 vaccinations 4 coded responses 17 check-ins 4 free-text entries 1 call case

Sex: Male
Age at first dose: 56-60
ZIP prefix: 304 / GA
Registered: 2021-01-15

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

2021-01-15
Registered in v-safe
2021-01-15
Dose 1 — Moderna
2021-01-15
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Muscle or body aches

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-22
Health check-in — day 7, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-12
Dose 2 — Moderna
2021-02-25
Health check-in — day 7, dose 2
Feeling: Good · Site: Redness, Itching · Headache

Adult check-in
2021-02-26
Survey response — day 14, dose 2
MedDRA: Diarrhoea, Dizziness, Nausea, Pain — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Major body aches and diarrhea. Very dizzy and nauseous

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-14
Survey response — 3 months, dose 2
MedDRA: Amnesia, Brain fog, Fatigue, Insomnia — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Extremely fatigued, foggy memory or ahort-term memory loss, trouble sleeping.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-15
Survey response — 6 months, dose 2
MedDRA: Cough, Lethargy, Muscle spasms, Pain, Parosmia, Rhinorrhoea, Vision blurred — Feeling: Fair · Be unable to do your normal daily activities

Free text: Some occasional coughing, lethargic, occasionally a runny nose, some different body aches than experienced in the past ( different areas of the body), muscle cramps, do not accurately smell things and occasionally have blurred vision.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-02-12
Survey response — 12 months, dose 2
MedDRA: Cough, Diarrhoea, Dyspnoea, Eye pruritus, Fatigue, Headache, Malaise, Office visit, Oxygen saturation decreased, Patient isolation, Pneumonia, Pyrexia, SARS-CoV-2 test positive — 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 · Telehealth, virtual health, or email health consultation, Hospitalization

Free text: Symptoms: I was COVID positive on Jan 20 and test was performed by doctors office. Coughing, fever, headaches, itchy eyes, low pulse ox of 87, shortness of breath, fatigue, diarrhea. I had to isolate at home. I had to take monoclonal Antib. In pill to get well · Healthcare visit (other): First one was in person bc thought it was still the pneumonia I had the week before

MedDRA releases: 2024-11 · check-in free text available
2022-02-12
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Hospitalization · 1 call case(s)
2022-02-15
Call 1 — Requested Callback
2022-02-16
Callback requested for
11:00AM ET
2022-02-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-12	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2022-02-12	Successful 2022-02-16	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 4 — day 14, dose 2

2021-02-26

Symptoms: Major body aches and diarrhea. Very dizzy and nauseous

Release 8 — 3 months, dose 2

2021-05-14

Symptoms: Extremely fatigued, foggy memory or ahort-term memory loss, trouble sleeping.

Release 9 — 6 months, dose 2

2021-08-15

Symptoms: Some occasional coughing, lethargic, occasionally a runny nose, some different body aches than experienced in the past ( different areas of the body), muscle cramps, do not accurately smell things and occasionally have blurred vision.

Release 11 — 12 months, dose 2

2022-02-12

Symptoms: I was COVID positive on Jan 20 and test was performed by doctors office. Coughing, fever, headaches, itchy eyes, low pulse ox of 87, shortness of breath, fatigue, diarrhea. I had to isolate at home. I had to take monoclonal Antib. In pill to get well cut off by CDC

Healthcare visit (other): First one was in person bc thought it was still the pneumonia I had the week before

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	·	·	✓
HCVO	Pneumonia	·	·	✓
SD	Amnesia	✓	✓	✓
SD	Brain fog	✓	✓	✓
SD	Cough	✓	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	·	·	✓
SD	Eye pruritus	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Insomnia	✓	✓	✓
SD	Lethargy	✓	·	✓
SD	Malaise	·	·	✓
SD	Muscle spasms	✓	·	✓
SD	Nausea	✓	✓	✓
SD	Office visit	·	·	✓
SD	Oxygen saturation decreased	·	·	✓
SD	Pain	✓	✓	✓
SD	Parosmia	✓	·	✓
SD	Patient isolation	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rhinorrhoea	✓	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Vision blurred	✓	·	✓

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