Z4P-16071-72108

2 vaccinations 6 coded responses 25 check-ins 6 free-text entries 7 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 280 / NC
Registered: 2020-12-31

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

2020-12-31
Registered in v-safe
2020-12-31
Dose 1 — Moderna
2020-12-31
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-01
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-01
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-02
Survey response — days 1–6 daily, dose 1
MedDRA: Glossodynia, Stomatitis — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Sores on my tongue and roof of my mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-02
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-03
Survey response — days 1–6 daily, dose 1
MedDRA: Glossodynia, Mastication disorder, Oral pain — Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work

Free text: The roof of my mouth and tongue is sore making it hard to eat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-03
Report sent to call center — days 1–6 daily, dose 1
Be unable to work

1 call case(s)
2021-01-04
Survey response — days 1–6 daily, dose 1
MedDRA: Medical counselling, Oral mucosal blistering, Tongue blistering — Feeling: Fair · Fever · Fatigue or tiredness · Be unable to work

Free text: Had to go to doctor about the blisters on the roof of my mouth and tongue

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

1 call case(s)
2021-01-05
Survey response — days 1–6 daily, dose 1
MedDRA: Candida infection, Pyrexia, Quarantine, Stomatitis — Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to work

Free text: Thrash and sores in my mouth. The company has quarantine me for 10 days due to running a fever the Friday after my shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-05
Report sent to call center — days 1–6 daily, dose 1
Be unable to work

1 call case(s)
2021-01-06
Survey response — days 1–6 daily, dose 1
MedDRA: Oral mucosal blistering — Feeling: Good · Fatigue or tiredness · Be unable to work

Free text: Still have blister in my mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-06
Report sent to call center — days 1–6 daily, dose 1
Be unable to work

1 call case(s)
2021-01-07
Survey response — day 7, dose 1
MedDRA: Eating disorder, Oral mucosal blistering — Feeling: Good · Be unable to work

Free text: Blisters in mouth. Dr prescribed a mouth wash that's working. Still difficult to eat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-07
Report sent to call center — day 7, dose 1
Be unable to work

1 call case(s)
2021-01-16
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-23
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-28
Dose 2 — Moderna
2021-01-28
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Chills, Fatigue or tiredness

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-18
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-29
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-01-28
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-31	Moderna
2	2021-01-28	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-01	priority 2/3
2021-01-02	priority 2/3
2021-01-03	priority 2/3
2021-01-04	priority 2/3
2021-01-05	priority 2/3
2021-01-06	priority 2/3
2021-01-07	priority 2/3

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-02

Systemic reaction (other): Sores on my tongue and roof of my mouth

2021-01-03

Systemic reaction (other): The roof of my mouth and tongue is sore making it hard to eat

2021-01-04

Systemic reaction (other): Had to go to doctor about the blisters on the roof of my mouth and tongue

2021-01-05

Systemic reaction (other): Thrash and sores in my mouth. The company has quarantine me for 10 days due to running a fever the Friday after my shot.

2021-01-06

Systemic reaction (other): Still have blister in my mouth

Release 1 — day 7, dose 1

2021-01-07

Systemic reaction (other): Blisters in mouth. Dr prescribed a mouth wash that's working. Still difficult to eat

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
SRO	Candida infection	✓	✓	✓
SRO	Eating disorder	✓	✓	✓
SRO	Glossodynia	✓	✓	✓
SRO	Mastication disorder	✓	✓	✓
SRO	Medical counselling	✓	✓	✓
SRO	Oral mucosal blistering	✓	✓	✓
SRO	Oral pain	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Quarantine	✓	✓	✓
SRO	Specialist consultation	○	○	○
SRO	Stomatitis	✓	✓	✓
SRO	Tongue blistering	✓	✓	✓

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