Z6R-15726-95028

4 vaccinations 6 coded responses 32 check-ins 6 free-text entries 3 call cases

Sex: Male
Age at first dose: 36-40
ZIP prefix: 190 / PA
Registered: 2021-04-08

Relationship: Self
Race: Asian
Ethnicity: Not Hispanic or Latino

Registered dependents

33Z-19077-24709 Child or adolescent in my care · Female · 2022-10-05

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-08
Registered in v-safe
2021-04-08
Dose 1 — Moderna
2021-04-08
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-04-09
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Fatigue, Immediate post-injection reaction, Injection site pain, Nausea — Feeling: Fair · Site: Pain

Free text: Very bad pain at the injection site. Whole shoulder is painful. I didnt mention this in the last report, but right after getting the shot, I did feel some nausea. Right after the shot, I did start to feel tired and exhausted.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Abdominal pain

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-15
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-06
Survey response — day 28, dose 1
MedDRA: Decreased appetite, Lethargy, Nausea, Pain, Pyrexia — Feeling: Fair · Be unable to work, 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

Free text: Extreme lethargy, fever of 100.6 on Monday 5/5/21, nausea, body aches, loss of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Report sent to call center — day 28, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-13
Dose 2 — Moderna
2021-05-13
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-05-14
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Muscle or body aches

Adult check-in
2021-05-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Adult check-in
2021-05-17
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains

Adult check-in
2021-05-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-05-20
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-27
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-17
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-13
Survey response — 3 months, dose 2
MedDRA: Chest discomfort — Feeling: Good

Free text: Chest, heart heaviness

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

Adult check-in
2021-12-09
Dose 3 — Moderna
2022-04-08
Call successful
Does not wish to fill out VAERS report
2022-05-13
Survey response — 12 months, dose 2
MedDRA: Anosmia, Cough, Headache, Influenza like illness, Office visit, Rhinorrhoea, Sinusitis — Feeling: Poor · Be unable to work or attend school, 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: Symptoms: Flu like symptoms, bad cough, headache, sinusitis, runny nose, loss of smell · Healthcare visit (other): PCP VISIT

MedDRA releases: 2024-11 · check-in free text available
2022-05-13
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-16
Call successful
Participant prefers to complete VAERS report online
2022-10-04
Dose 4 — Pfizer-BioNTech
2022-10-05
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Headache, 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: Good · Site: Pain, Swelling · None

Adult check-in
2022-10-08
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Joint pains

Adult check-in
2022-11-01
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-08
Survey response — day 35, dose 4
MedDRA: Rhinorrhoea — Feeling: Good

Free text: Mild runny nose

MedDRA releases: 2024-11 · check-in free text available
2022-11-15
Survey response — day 42, dose 4
MedDRA: Angina pectoris — Feeling: Good

Free text: Occasional heart pain

MedDRA releases: 2024-11 · check-in free text available
2023-01-03
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-08	Moderna
2	2021-05-13	Moderna
3	2021-12-09	Moderna	No
4	2022-10-04	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-05-06	Successful	Does not wish to fill out VAERS report
2021-05-17	Successful 2022-04-08	Does not wish to fill out VAERS report
2022-05-13	Successful 2022-05-16	Participant prefers to complete VAERS report online

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-09

Systemic reaction (other): Very bad pain at the injection site. Whole shoulder is painful. I didnt mention this in the last report, but right after getting the shot, I did feel some nausea. Right after the shot, I did start to feel tired and exhausted.

Release 8 — day 28, dose 1

2021-05-06

Symptoms: Extreme lethargy, fever of 100.6 on Monday 5/5/21, nausea, body aches, loss of appetite

Release 9 — 3 months, dose 2

2021-08-13

Symptoms: Chest, heart heaviness

Release 11 — 12 months, dose 2

2022-05-13

Symptoms: Flu like symptoms, bad cough, headache, sinusitis, runny nose, loss of smell

Healthcare visit (other): PCP VISIT

Release 12 — day 35, dose 4

2022-11-08

Symptoms: Mild runny nose

Release 12 — day 42, dose 4

2022-11-15

Symptoms: Occasional heart pain

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	Angina pectoris	·	·	✓
SD	Anosmia	·	·	✓
SD	Chest discomfort	✓	·	✓
SD	Cough	·	·	✓
SD	Decreased appetite	✓	✓	✓
SD	Headache	·	·	✓
SD	Influenza like illness	·	·	✓
SD	Lethargy	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	Sinusitis	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Nausea	✓	✓	✓

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