YXU-85107-32716

3 vaccinations 7 coded responses 32 check-ins 7 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 805 / CO
Registered: 2021-01-16

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
Dose 1 — Moderna
2021-01-16
Registered in v-safe
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Lethargy, Rhinorrhoea, Sneezing — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Runny nose, sneezing, lethargy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — day 7, dose 1
Feeling: Good · None

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
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Eye swelling, Hypersensitivity, Pre-existing disease, Sinus headache — Feeling: Poor · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Allergic reactions - swollen eyes, sinus headache, deep cough, asthma

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Respiratory tract congestion — Feeling: Good

Free text: Chest congestion and cough remain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Cough, Upper respiratory tract congestion — Feeling: Good · Fatigue or tiredness

Free text: Chest congestion and cough and a little asthma but improving.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Cough — Feeling: Good

Free text: Still a little asthma and occasional cough - getting better by the day

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Health check-in — day 7, dose 2
Feeling: Fair · Fever · Chills, Headache, Joint pains, Fatigue or tiredness, Diarrhea

Adult check-in
2021-02-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 21, dose 2
Feeling: Good

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
2021-03-27
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-13
Survey response — 6 months, dose 2
MedDRA: Bronchitis, Eye swelling, Fatigue, Headache, Office visit, Oropharyngeal pain, Respiratory tract congestion, SARS-CoV-2 test negative, Viral infection — 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 · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Viral infection. Sore throat, headache, congestion, bronchitis, extreme fatigue, swollen eyes. No fever. Negative tests for strep and Covid. · Healthcare visit (other): Family Doctor office visit

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-13
Report sent to call center — 6 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

1 call case(s)
2021-08-18
Call 1 — Could Not Reach Participant
2021-08-23
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-22
Dose 3 — Moderna
2021-10-24
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling · Muscle or body aches

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-29
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-07
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-13
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-05
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-21
Survey response — 3 months, dose 3
MedDRA: Arthralgia, Cough, Headache, Oropharyngeal pain, Pyrexia, Respiratory tract congestion, Sneezing — Feeling: Poor · Be unable to do your normal daily activities

Free text: Sore throat, congestion, coughing, sneezing, roaring headache, low grade fever, joint aches

MedDRA releases: 2024-11 · check-in free text available
2022-04-22
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-12	Moderna
3	2021-10-22	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-16	priority 2/3
2021-08-13	Successful 2021-08-23	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-16

Systemic reaction (other): Runny nose, sneezing, lethargy

Release 4 — days 1–6 daily, dose 2

2021-02-14

Systemic reaction (other): Allergic reactions - swollen eyes, sinus headache, deep cough, asthma

2021-02-15

Systemic reaction (other): Chest congestion and cough remain.

2021-02-16

Systemic reaction (other): Chest congestion and cough and a little asthma but improving.

2021-02-17

Systemic reaction (other): Still a little asthma and occasional cough - getting better by the day

Release 9 — 6 months, dose 2

2021-08-13

Symptoms: Viral infection. Sore throat, headache, congestion, bronchitis, extreme fatigue, swollen eyes. No fever. Negative tests for strep and Covid.

Healthcare visit (other): Family Doctor office visit

Release 11 — 3 months, dose 3

2022-01-21

Symptoms: Sore throat, congestion, coughing, sneezing, roaring headache, low grade fever, joint aches

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	Arthralgia	·	·	✓
SD	Bronchitis	✓	·	✓
SD	Cough	·	·	✓
SD	Eye swelling	✓	·	✓
SD	Fatigue	✓	·	✓
SD	Headache	✓	·	✓
SD	Oropharyngeal pain	✓	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory tract congestion	✓	·	✓
SD	SARS-CoV-2 test negative	✓	·	✓
SD	Sneezing	·	·	✓
SD	Viral infection	✓	·	✓
SRO	Asthma	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Eye swelling	✓	✓	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Lethargy	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sinus headache	✓	✓	✓
SRO	Sneezing	✓	✓	✓
SRO	Upper respiratory tract congestion	✓	✓	✓

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