Z6X-21037-29900

4 vaccinations 12 coded responses 37 check-ins 12 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 981 / WA
Registered: 2021-01-31

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

2021-01-30
Dose 1 — Moderna
2021-01-31
Registered in v-safe
2021-01-31
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Headache, Injection site discomfort, Photophobia — Feeling: Good · Headache

Free text: I have MS so fatique is a normal daily occurrence. Discomfort of shot was not noticeable compared to my daily Copaxone sight a. The very temporary headache/light sensitivity was new.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

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

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-05
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Site: Itching

Free text: A little tenderness at the injection site. It could be just my MS.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — day 7, dose 1
MedDRA: Injection site erythema, Injection site pruritus — Feeling: Good · Site: Itching

Free text: Very mild redness around the injection site, that where itching became a couple of days ago.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-20
Survey response — day 21, dose 1
MedDRA: Migraine, Multiple sclerosis, Muscle spasms, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Muscle spasms for last 3 days and migraines probably due to MS desease. Copaxone site reactions more severe than usual. I've skipped a few Copaxone shots due the last week to let my skin recover a little. Mainly I feel it is probably not due to vacc.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Dose 2 — Moderna
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: Testicular pain — Feeling: Good · Site: Pain · Abdominal pain

Free text: Testicular pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Dry eye — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: Dry eyes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — day 7, dose 2
MedDRA: Asthenopia — Feeling: Good · Fatigue or tiredness

Free text: Eye strain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-30
Survey response — day 35, dose 2
MedDRA: Abdominal distension, Abnormal faeces, Constipation, Fatigue, Pre-existing disease, Respiratory tract congestion — Feeling: Good

Free text: Mild constipation and tiredness and stomach bloating, could just be MS symptoms especially the latter two. Very large stools and mild constipation are new symptoms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-08
Dose 3 — Moderna
2022-02-25
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-05-06
Dose 4 — Moderna
2022-05-08
Survey response — days 1–6 daily, dose 4
MedDRA: Abdominal pain — Feeling: Good · Fever · Abdominal pain

Free text: I had abdominal pain before the shot so I don't think it's related.

MedDRA releases: 2024-11 · check-in free text available
2022-05-09
Survey response — days 1–6 daily, dose 4
MedDRA: Pre-existing disease — Feeling: Good · Abdominal pain

Free text: Abdominal pains began before the shot.

MedDRA releases: 2024-11 · check-in free text available
2022-05-10
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-11
Survey response — days 1–6 daily, dose 4
MedDRA: Erythema, Rash — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Rash on both ankles, left ankle & foot bright pink, not itchy simply noticed in shower..

MedDRA releases: 2024-11 · check-in free text available
2022-05-12
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-13
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-21
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-27
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-03
Survey response — day 28, dose 4
MedDRA: Abdominal pain, Adverse reaction, Office visit, Pain, Pain in extremity — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Abdominal pains Lower leg soreness · Healthcare visit (other): In person GP visit, blood work resolved to normal now but still having less painful symptoms.

MedDRA releases: 2024-11 · check-in free text available
2022-06-03
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-06-06
Call 1 — Left Voicemail
2022-06-10
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-17
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-07
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-04
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-06
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-30	Moderna
2	2021-02-23	Moderna
3	2021-11-08	Moderna	No
4	2022-05-06	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-06-03	Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 1

2021-01-31

Systemic reaction (other): I have MS so fatique is a normal daily occurrence. Discomfort of shot was not noticeable compared to my daily Copaxone sight a. The very temporary headache/light sensitivity was new.

2021-02-05

Systemic reaction (other): A little tenderness at the injection site. It could be just my MS.

Release 3 — day 7, dose 1

2021-02-06

Systemic reaction (other): Very mild redness around the injection site, that where itching became a couple of days ago.

Release 4 — day 21, dose 1

2021-02-20

Symptoms: Muscle spasms for last 3 days and migraines probably due to MS desease. Copaxone site reactions more severe than usual. I've skipped a few Copaxone shots due the last week to let my skin recover a little. Mainly I feel it is probably not due to vacc. cut off by CDC

Release 4 — days 1–6 daily, dose 2

2021-02-25

Systemic reaction (other): Testicular pain

2021-03-01

Systemic reaction (other): Dry eyes

Release 4 — day 7, dose 2

2021-03-02

Systemic reaction (other): Eye strain

Release 6 — day 35, dose 2

2021-03-30

Symptoms: Mild constipation and tiredness and stomach bloating, could just be MS symptoms especially the latter two. Very large stools and mild constipation are new symptoms.

Release 11 — days 1–6 daily, dose 4

2022-05-08

Systemic reaction (other): I had abdominal pain before the shot so I don't think it's related.

2022-05-09

Systemic reaction (other): Abdominal pains began before the shot.

2022-05-11

Systemic reaction (other): Rash on both ankles, left ankle & foot bright pink, not itchy simply noticed in shower..

Release 11 — day 28, dose 4

2022-06-03

Symptoms: Abdominal pains Lower leg soreness

Healthcare visit (other): In person GP visit, blood work resolved to normal now but still having less painful symptoms.

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	Adverse reaction	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Pain	·	·	✓
SD	Abdominal distension	✓	✓	✓
SD	Abdominal pain	·	·	✓
SD	Abnormal faeces	✓	✓	✓
SD	Constipation	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Migraine	✓	✓	✓
SD	Multiple sclerosis	✓	✓	✓
SD	Muscle spasms	✓	✓	✓
SD	Pain in extremity	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Respiratory tract congestion	✓	✓	✓
SRO	Abdominal pain	·	·	✓
SRO	Asthenopia	✓	✓	✓
SRO	Dry eye	✓	✓	✓
SRO	Erythema	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Injection site discomfort	✓	✓	✓
SRO	Injection site erythema	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Injection site pruritus	✓	✓	✓
SRO	Photophobia	✓	✓	✓
SRO	Pre-existing disease	·	·	✓
SRO	Rash	·	·	✓
SRO	Testicular pain	✓	✓	✓

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