Z3N-18626-41503

5 vaccinations 17 coded responses 48 check-ins 18 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 993 / WA
Registered: 2021-02-05

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

2021-02-05
Registered in v-safe
2021-02-05
Dose 1 — Moderna
2021-02-05
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

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

Adult check-in
2021-02-14
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-19
Survey response — day 14, dose 1
MedDRA: Arthralgia, Ligament sprain — Feeling: Good

Free text: Sprained ankle pain worsened

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-05
Dose 2 — Moderna
2021-03-05
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: Pain — Feeling: Good

Free text: Slight superficial pain with no visible cause. Onset after 1st shot and continuing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Survey response — day 7, dose 2
MedDRA: Contusion — Feeling: Good

Free text: Unexplained bruises on forearms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-02
Survey response — day 28, dose 2
MedDRA: Arthralgia — Feeling: Good

Free text: Unexplained superficial pain on back of R wrist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Survey response — day 42, dose 2
MedDRA: Arthralgia, Joint range of motion decreased — Feeling: Good · Be unable to do your normal daily activities

Free text: L knee pain & loss of flexibility

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-05
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Neck pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Sore R neck, very sore L knee

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-04
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-24
Dose 3 — Moderna
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: Balance disorder — Feeling: Good · Site: Redness

Free text: Slight loss of balance - first in many years

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Good · Abdominal pain

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
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
2021-11-14
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-21
Survey response — day 28, dose 3
MedDRA: Pain — Feeling: Fair

Free text: Body aches

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Health check-in — day 35, dose 3
Feeling: Fair

Free text: Fatigue

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

Adult check-in
2022-01-24
Survey response — 3 months, dose 3
MedDRA: Neck pain — Feeling: Good

Free text: Sore neck

MedDRA releases: 2024-11 · check-in free text available
2022-06-10
Dose 4 — Moderna
2022-06-10
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-06-11
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-06-12
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-06-13
Survey response — days 1–6 daily, dose 4
MedDRA: Unevaluable event — Feeling: Good · Joint pains

Free text: Ankle

MedDRA releases: 2024-11 · check-in free text available
2022-06-17
Health check-in — day 7, dose 4
Feeling: Good · Diarrhea

Adult check-in
2022-06-24
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-07-01
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-07-09
Survey response — day 28, dose 4
MedDRA: Heart rate increased — Feeling: Good

Free text: Fast heart rate with moderate exertion

MedDRA releases: 2024-11 · check-in free text available
2022-07-15
Survey response — day 35, dose 4
MedDRA: Fatigue — Feeling: Fair

Free text: Fatigued

MedDRA releases: 2024-11 · check-in free text available
2022-07-22
Survey response — day 42, dose 4
MedDRA: Muscle spasms, Nausea — Feeling: Good

Free text: Nausea and cramps

MedDRA releases: 2024-11 · check-in free text available
2022-09-09
Survey response — 3 months, dose 4
MedDRA: Joint stiffness, Stiff leg syndrome — Feeling: Fair · Be unable to do your normal daily activities

Free text: Joint pain and stiffness in legs and ankles

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Dose 5 — Moderna
2022-10-19
Health check-in — day 0, dose 5
Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school

Adult check-in
2022-10-21
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-22
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Joint pains · Be unable to do your normal daily activities

Adult check-in
2022-10-25
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2022-10-26
Health check-in — day 7, dose 5
Feeling: Fair · Joint pains · Be unable to do your normal daily activities

Adult check-in
2022-11-02
Health check-in — day 14, dose 5
Feeling: Fair

Adult check-in
2022-11-09
Health check-in — day 21, dose 5
Feeling: Fair

Adult check-in
2022-11-17
Survey response — day 28, dose 5
MedDRA: Fatigue, Medical counselling — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: For the first time during my biweekly hike up a 900' elevation I experienced extreme fatigue · Healthcare visit (other): Phone calls

MedDRA releases: 2024-11 · check-in free text available
2022-11-17
Report sent to call center — day 28, dose 5
Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-18
Call 1 — Could Not Reach Participant
2022-11-23
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2022-11-30
Survey response — day 42, dose 5
MedDRA: Balance disorder, Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Very fatigued and unsteady but not dizzy

MedDRA releases: 2024-11 · check-in free text available
2023-01-18
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-05	Moderna
3	2021-10-24	Moderna	No
4	2022-06-10	Moderna	No
5	2022-10-19	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-11-17	Unsuccessful

Free text

Release 4 — day 14, dose 1

2021-02-19

Symptoms: Sprained ankle pain worsened

Release 5 — days 1–6 daily, dose 2

2021-03-09

Systemic reaction (other): Slight superficial pain with no visible cause. Onset after 1st shot and continuing

Release 5 — day 7, dose 2

2021-03-14

Systemic reaction (other): Unexplained bruises on forearms

Release 6 — day 28, dose 2

2021-04-02

Symptoms: Unexplained superficial pain on back of R wrist

Release 7 — day 42, dose 2

2021-04-16

Symptoms: L knee pain & loss of flexibility

Release 8 — 3 months, dose 2

2021-06-05

Symptoms: Sore R neck, very sore L knee

Release 10 — days 1–6 daily, dose 3

2021-10-27

Systemic reaction (other): Slight loss of balance - first in many years

2021-10-29

Systemic reaction (other): No

Release 10 — day 28, dose 3

2021-11-21

Symptoms: Body aches

Release 11 — 3 months, dose 3

2022-01-24

Symptoms: Sore neck

Release 12 — day 35, dose 3

2021-11-28

Symptoms: Fatigue

Release 12 — days 1–6 daily, dose 4

2022-06-13

Systemic reaction (other): Ankle

Release 12 — day 28, dose 4

2022-07-09

Symptoms: Fast heart rate with moderate exertion

Release 12 — day 35, dose 4

2022-07-15

Symptoms: Fatigued

Release 12 — day 42, dose 4

2022-07-22

Symptoms: Nausea and cramps

Release 12 — 3 months, dose 4

2022-09-09

Symptoms: Joint pain and stiffness in legs and ankles

Release 12 — day 28, dose 5

2022-11-17

Symptoms: For the first time during my biweekly hike up a 900' elevation I experienced extreme fatigue

Healthcare visit (other): Phone calls

Release 12 — day 42, dose 5

2022-11-30

Symptoms: Very fatigued and unsteady but not dizzy

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	Arthralgia	✓	✓	✓
SD	Balance disorder	·	·	✓
SD	Fatigue	·	·	✓
SD	Heart rate increased	·	·	✓
SD	Joint range of motion decreased	✓	✓	✓
SD	Joint stiffness	·	·	✓
SD	Ligament sprain	✓	✓	✓
SD	Muscle spasms	·	·	✓
SD	Nausea	·	·	✓
SD	Neck pain	✓	✓	✓
SD	Pain	·	·	✓
SD	Stiff leg syndrome	·	·	✓
SRO	Balance disorder	·	·	✓
SRO	Contusion	✓	✓	✓
SRO	No adverse event	·	·	✓
SRO	Pain	✓	✓	✓
SRO	Unevaluable event	·	·	✓

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