Z4W-27559-47597

4 vaccinations 10 coded responses 50 check-ins 8 free-text entries 4 call cases

Sex: Male
Age at first dose: 36-40
ZIP prefix: 980 / WA
Registered: 2021-01-02

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

2021-01-02
Registered in v-safe
2021-01-02
Dose 1 — Moderna
2021-01-02
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain, Redness · Diarrhea

Adult check-in
2021-01-03
Survey response — days 1–6 daily, dose 1
MedDRA: Dry eye — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dry eyes

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 do your normal daily activities

1 call case(s)
2021-01-05
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · None

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-16
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-30
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-01-31
Dose 2 — Moderna
2021-01-31
Survey response — day 0, dose 2
MedDRA: Feeling abnormal — Feeling: Poor · Fever · Chills, Headache

Free text: Brain fog-hard to concentrate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-02-04
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Shortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Fatigue or tiredness

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-07
Health check-in — day 7, dose 2
Feeling: Good · None

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

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

Adult check-in
2021-02-28
Survey response — day 28, dose 2
MedDRA: Myalgia, Oropharyngeal pain — Feeling: Fair

Free text: Sore throat and muscle aches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-14
Survey response — day 42, dose 2
MedDRA: Cough, Dyspnoea, Dyspnoea exertional, Heart rate abnormal — Feeling: Fair · Be unable to do your normal daily activities

Free text: Difficultly breathing after workout, persistent cough starting almost exactly 20 minutes after strenuous cardio workout followed by slower than average return to resting heart rate.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Survey response — 3 months, dose 2
MedDRA: Cough, Office visit, Wheezing — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: I have developed a strong cough and wheezing when working out or immediately after stopping a workout.Using albuterol pre-workout/strenuous activity seems to help. · Healthcare visit (other): My primary care in person

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-17
Call 1 — Left Voicemail
2021-08-01
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-11-10
Dose 3 — Moderna
2021-11-10
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-11
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-12
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-13
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-14
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2021-11-15
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2021-11-16
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Joint pains, Muscle or body aches

Adult check-in
2021-11-17
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2021-11-24
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-24
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-09
Survey response — 3 months, dose 3
MedDRA: Joint range of motion decreased — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Loss of ROM in left shoulder where injection took olace

MedDRA releases: 2024-11 · check-in free text available
2022-02-09
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-11
Call successful
Does not wish to fill out VAERS report
2022-05-11
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-03
Dose 4 — Moderna
2022-10-05
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-06
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-07
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-09
Survey response — days 1–6 daily, dose 4
MedDRA: Poor quality sleep — Feeling: Good · Fatigue or tiredness

Free text: Sleeping worse

MedDRA releases: 2024-11 · check-in free text available
2022-10-10
Health check-in — day 7, dose 4
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-17
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-24
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-31
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-16
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-01-02
Survey response — 3 months, dose 4
MedDRA: Eye discharge, Productive cough, Secretion discharge, Sputum discoloured — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-04-04
Survey response — 6 months, dose 4
MedDRA: Asthma exercise induced, Duodenal ulcer, Dyspnoea — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-04-04
Report sent to call center — 6 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2023-04-05
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-02	Moderna
2	2021-01-31	Moderna
3	2021-11-10	Moderna	No
4	2022-10-03	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-03	priority 2/3
2021-05-02	Successful 2022-02-11	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-09	Successful 2022-02-11	Does not wish to fill out VAERS report
2023-04-04	Unsuccessful

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-03

Systemic reaction (other): Dry eyes

Release 3 — day 0, dose 2

2021-01-31

Systemic reaction (other): Brain fog-hard to concentrate

Release 3 — days 1–6 daily, dose 2

2021-02-04

Systemic reaction (other): Shortness of breath

Release 4 — day 28, dose 2

2021-02-28

Symptoms: Sore throat and muscle aches

Release 5 — day 42, dose 2

2021-03-14

Symptoms: Difficultly breathing after workout, persistent cough starting almost exactly 20 minutes after strenuous cardio workout followed by slower than average return to resting heart rate.

Release 8 — 3 months, dose 2

2021-05-02

Symptoms: I have developed a strong cough and wheezing when working out or immediately after stopping a workout.Using albuterol pre-workout/strenuous activity seems to help.

Healthcare visit (other): My primary care in person

Release 11 — 3 months, dose 3

2022-02-09

Symptoms: Loss of ROM in left shoulder where injection took olace

Release 12 — days 1–6 daily, dose 4

2022-10-09

Systemic reaction (other): Sleeping worse

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	Asthma exercise induced	·	·	✓
SD	Cough	✓	✓	✓
SD	Duodenal ulcer	·	·	✓
SD	Dyspnoea	○	✓	✓
SD	Dyspnoea exertional	✓	·	✓
SD	Eye discharge	·	·	✓
SD	Heart rate abnormal	✓	✓	✓
SD	Joint range of motion decreased	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Productive cough	·	·	✓
SD	Secretion discharge	·	·	✓
SD	Sputum discoloured	·	·	✓
SD	Wheezing	✓	✓	✓
SRO	Dry eye	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Poor quality sleep	·	·	✓

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