Z5V-25310-47443

3 vaccinations 13 coded responses 34 check-ins 13 free-text entries 10 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 220 / VA
Registered: 2021-02-01

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

2021-02-01
Registered in v-safe
2021-02-01
Dose 1 — Moderna
2021-02-01
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Muscle or body aches

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-02-08
Health check-in — day 7, dose 1
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-15
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-22
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-03-01
Dose 2 — Moderna
2021-03-01
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

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

Adult check-in
2021-03-04
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: General tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-08
Health check-in — day 7, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-15
Survey response — day 14, dose 2
MedDRA: Pain — Feeling: Fair

Free text: Body aches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-29
Survey response — day 28, dose 2
MedDRA: Dyspnoea, Fatigue — Feeling: Good

Free text: Tiredness short of breath. Just out of shape

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-31
Survey response — 3 months, dose 2
MedDRA: Cough, Dyspnoea, Medical counselling, SARS-CoV-2 test negative — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Shallow cough/short of breath. Being treated by pulmonologist. All COVID testing negative.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-31
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-30
Survey response — 6 months, dose 2
MedDRA: Cough, Fatigue — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Persistent cough and fatigue

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-30
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-31
Call 1 — Left Voicemail
2021-10-29
Dose 3 — Moderna
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache, Joint pains, Diarrhea

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Adult check-in
2021-11-01
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Arthralgia, Cough, Physiotherapy — Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Constant shallow cough since March 2001 following 2nd COVID vaccine · Healthcare visit (other): Physical therapy fir shoulder and hip pain. Feel unrelated to COVID

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-03
Call successful
Participant prefers to complete VAERS report online
2021-11-05
Survey response — day 7, dose 3
MedDRA: Office visit, Physiotherapy — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Diarrhea · Get care from a doctor or other healthcare professional

Free text: Physical therapy/pain management

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Report sent to call center — day 7, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-09
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-12
Survey response — day 14, dose 3
MedDRA: Arthralgia, Diarrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Aching joints/diarrhea

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Survey response — day 21, dose 3
MedDRA: Diarrhoea, Functional gastrointestinal disorder, Office visit, Pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Continue to have diarrhea for over a week and body aches continue. Have seen urgent care regarding bowel distress. Awaiting results of labs.

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Report sent to call center — day 21, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-23
Call 1 — Left Voicemail
2021-11-26
Survey response — day 28, dose 3
MedDRA: Arthralgia, Diarrhoea, Myalgia — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Muscle/joint aches continue as well as diarrhea

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-29
Call 1 — Left Voicemail
2021-11-30
Call 2 — Left Voicemail
2021-12-03
Survey response — day 35, dose 3
MedDRA: Diarrhoea — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Went for CT of abdomen. Diarrhea continues intermittently

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Report sent to call center — day 35, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-07
Call 1 — Left Voicemail
2021-12-12
Survey response — day 42, dose 3
MedDRA: Diarrhoea, Pain — Feeling: Fair · 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: Aching and diarrhea continues

MedDRA releases: 2024-11 · check-in free text available
2021-12-12
Report sent to call center — day 42, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-13
Call 1 — Left Voicemail
2022-01-28
Survey response — 3 months, dose 3
MedDRA: Abdominal pain, Diarrhoea — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Diarrhea continues with abdomen soreness.

MedDRA releases: 2024-11 · check-in free text available
2022-01-28
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)
2022-02-01
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-01	Moderna
2	2021-03-01	Moderna
3	2021-10-29	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-05-31	Successful	Participant prefers to complete VAERS report online
2021-08-30	Successful	Participant prefers to complete VAERS report online
2021-11-01	Successful 2021-11-03	Participant prefers to complete VAERS report online
2021-11-03	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-05	Successful 2021-11-09	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-19	Unsuccessful
2021-11-26	Unsuccessful
2021-12-03	Unsuccessful
2021-12-12	Unsuccessful
2022-01-28	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-04

Systemic reaction (other): General tiredness

Release 5 — day 14, dose 2

2021-03-15

Symptoms: Body aches

Release 6 — day 28, dose 2

2021-03-29

Symptoms: Tiredness short of breath. Just out of shape

Release 8 — 3 months, dose 2

2021-05-31

Symptoms: Shallow cough/short of breath. Being treated by pulmonologist. All COVID testing negative.

Release 9 — 6 months, dose 2

2021-08-30

Symptoms: Persistent cough and fatigue

Release 10 — days 1–6 daily, dose 3

2021-11-03

Systemic reaction (other): Constant shallow cough since March 2001 following 2nd COVID vaccine

Healthcare visit (other): Physical therapy fir shoulder and hip pain. Feel unrelated to COVID

Release 10 — day 7, dose 3

2021-11-05

Healthcare visit (other): Physical therapy/pain management

Release 10 — day 14, dose 3

2021-11-12

Symptoms: Aching joints/diarrhea

Release 10 — day 21, dose 3

2021-11-19

Symptoms: Continue to have diarrhea for over a week and body aches continue. Have seen urgent care regarding bowel distress. Awaiting results of labs.

Release 10 — day 28, dose 3

2021-11-26

Symptoms: Muscle/joint aches continue as well as diarrhea

Release 10 — day 35, dose 3

2021-12-03

Symptoms: Went for CT of abdomen. Diarrhea continues intermittently

Release 10 — day 42, dose 3

2021-12-12

Symptoms: Aching and diarrhea continues

Release 11 — 3 months, dose 3

2022-01-28

Symptoms: Diarrhea continues with abdomen soreness.

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	Arthralgia	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Physiotherapy	·	·	✓
SD	Abdominal pain	·	·	✓
SD	Arthralgia	·	·	✓
SD	Cough	✓	✓	✓
SD	Diarrhoea	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Functional gastrointestinal disorder	·	·	✓
SD	Medical counselling	✓	✓	✓
SD	Myalgia	·	·	✓
SD	Office visit	·	·	✓
SD	Pain	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SRO	Cough	·	·	✓
SRO	Fatigue	✓	✓	✓

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