Z5V-27755-80111

3 vaccinations 10 coded responses 25 check-ins 10 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 232 / VA
Registered: 2021-02-15

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

2021-02-14
Dose 1 — Moderna
2021-02-15
Registered in v-safe
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-02-16
Survey response — days 1–6 daily, dose 1
MedDRA: Blood pressure decreased — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Blood pressure very low: 95/50

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea, Fatigue — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Fatigue-I am unable to complete my daily exercise without becoming winded and feeling like I cant catch my breath.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — days 1–6 daily, dose 1
MedDRA: Muscular weakness — Feeling: Fair · Fatigue or tiredness

Free text: Muscle weakness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — days 1–6 daily, dose 1
MedDRA: Hypotension — Feeling: Fair · Muscle or body aches, Fatigue or tiredness · 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: Low blood pressure (100/50); unable to complete normal exercise routine before reaching total exhaustion.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-21
Survey response — day 7, dose 1
MedDRA: Dyspnoea — Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Short of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-03-08
Survey response — day 21, dose 1
MedDRA: Cough, Dyspnoea, Fatigue, Influenza, Vomiting — Feeling: Good · Be unable to do your normal daily activities

Free text: Flu symptoms including vomiting,fatigue, shortness of breath and cough.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Dose 2 — Moderna
2021-03-14
Health check-in — day 0, dose 2
Feeling: Fair · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Chills, Headache, Joint pains

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-23
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-29
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-04
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-11
Survey response — day 28, dose 2
MedDRA: Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities

Free text: Surgery unrelated to COVID

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-13
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-11
Call 1 — Left Voicemail
2021-08-11
Call successful
Does not wish to fill out VAERS report
2021-09-14
Survey response — 6 months, dose 2
MedDRA: Neoplasm malignant — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Cancer

MedDRA releases: 2024-11 · check-in free text available
2021-09-14
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-15
Call 1 — Could Not Reach Participant
2021-09-22
Dose 3 — Moderna
2021-10-28
Survey response — day 35, dose 3
MedDRA: Chemotherapy, Sarcoma — Feeling: Fair · 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Sarcoma and chemotherapy

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Report sent to call center — day 35, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-10-29
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-03
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2021-12-22
Survey response — 3 months, dose 3
MedDRA: Chemotherapy, Neoplasm malignant — Feeling: Fair · 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: I have been in chemotherapy for cancer. My doc recently tested me for vaccine related antibodies and found I had none, even though I have had two doses and a booster.

MedDRA releases: 2024-11 · check-in free text available
2021-12-22
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-12-23
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-14	Moderna
2	2021-03-14	Moderna
3	2021-09-22	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-19	Successful 2021-08-11	Does not wish to fill out VAERS report
2021-09-14	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-28	Successful 2021-10-29	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-22	Successful 2021-12-23	Participant prefers to complete VAERS report online

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-16

Systemic reaction (other): Blood pressure very low: 95/50

2021-02-17

Systemic reaction (other): Fatigue-I am unable to complete my daily exercise without becoming winded and feeling like I cant catch my breath.

2021-02-18

Systemic reaction (other): Muscle weakness

2021-02-19

Systemic reaction (other): Low blood pressure (100/50); unable to complete normal exercise routine before reaching total exhaustion.

Release 4 — day 7, dose 1

2021-02-21

Systemic reaction (other): Short of breath

Release 5 — day 21, dose 1

2021-03-08

Symptoms: Flu symptoms including vomiting,fatigue, shortness of breath and cough.

Release 7 — day 28, dose 2

2021-04-11

Symptoms: Surgery unrelated to COVID

Release 9 — 6 months, dose 2

2021-09-14

Symptoms: Cancer

Release 10 — day 35, dose 3

2021-10-28

Symptoms: Sarcoma and chemotherapy

Release 10 — 3 months, dose 3

2021-12-22

Symptoms: I have been in chemotherapy for cancer. My doc recently tested me for vaccine related antibodies and found I had none, even though I have had two doses and a booster.

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
SD	Chemotherapy	·	·	✓
SD	Cough	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Influenza	✓	✓	✓
SD	Neoplasm malignant	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Sarcoma	·	·	✓
SD	Vomiting	✓	✓	✓
SRO	Blood pressure decreased	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Hypotension	✓	✓	✓
SRO	Muscular weakness	✓	✓	✓

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