Z7Z-16941-79055

2 vaccinations 11 coded responses 23 check-ins 11 free-text entries 1 call case

Sex: Male
Age at first dose: 41-45
ZIP prefix: 981 / WA
Registered: 2021-08-04

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

2021-07-30
Dose 1 — Moderna
2021-08-04
Registered in v-safe
2021-08-04
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea, Hypersensitivity, Hypoaesthesia, Immediate post-injection reaction, Office visit, Respiratory arrest — Feeling: Fair · Site: Pain · 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: 35 minutes after vaccine, the numbness in my face, five hours after had trouble breathing and stopped breathing a few times. After doctor visit what all I had mild allergic reaction.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-04
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)
2021-08-05
Survey response — days 1–6 daily, dose 1
MedDRA: Asthenia, Dry mouth — Feeling: Fair · Fatigue or tiredness

Free text: Still have dry mouth, energy level low

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-06
Health check-in — day 7, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-08-13
Survey response — day 14, dose 1
MedDRA: Asthma, Pre-existing disease — Feeling: Fair

Free text: My asthma

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-16
Call 1 — Left Voicemail
2021-08-20
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-08-29
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-09-03
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-09-10
Dose 2 — Moderna
2021-09-10
Survey response — day 0, dose 2
MedDRA: Immunisation reaction — Feeling: Fair · Site: Pain

Free text: My Dr. had me take hydroxyzine pam 1 hour before my Second vaccination to prevent the mild allergic reaction I had last time so far so good. Its been five hours since I took the shot.

MedDRA releases: 2024-11 · check-in free text available
2021-09-11
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea, Wheezing — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Shortness of breath/wheezing.

MedDRA releases: 2024-11 · check-in free text available
2021-09-12
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea — Feeling: Fair · Site: Redness · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2021-09-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness · Fatigue or tiredness

Adult check-in
2021-09-14
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Redness · Fatigue or tiredness

Free text: Just for tea and a little bit of dizziness

MedDRA releases: 2024-11 · check-in free text available
2021-09-15
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Asthma, Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: Still messing with my asthma a little bit and not having normal energy levels return

MedDRA releases: 2024-11 · check-in free text available
2021-09-16
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Cough variant asthma, Fatigue, Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: A little bit of fatigue but feeling better mainly still dealing with triggered asthma cough

MedDRA releases: 2024-11 · check-in free text available
2021-09-17
Survey response — day 7, dose 2
MedDRA: Asthma, Fatigue, Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: Fatigue is almost gone and whats left may be related to triggered asthma.

MedDRA releases: 2024-11 · check-in free text available
2021-09-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-10-01
Health check-in — day 21, dose 2
Feeling: Fair

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

Adult check-in
2021-10-15
Survey response — day 35, dose 2
MedDRA: Asthma, Pre-existing disease, Unevaluable event, Vaccine positive rechallenge — Feeling: Fair

Free text: I did have a similar struggle with my asthma that I had to my first vaccine that I had a allergic reaction to but it didn't last that long.

MedDRA releases: 2024-11 · check-in free text available
2021-10-22
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-12-10
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-03-13
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-09-10
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-07-30	Moderna	No
2	2021-09-10	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-08-04	Unsuccessful

Free text

Release 9 — days 1–6 daily, dose 1

2021-08-04

Systemic reaction (other): 35 minutes after vaccine, the numbness in my face, five hours after had trouble breathing and stopped breathing a few times. After doctor visit what all I had mild allergic reaction.

2021-08-05

Systemic reaction (other): Still have dry mouth, energy level low

Release 9 — day 14, dose 1

2021-08-13

Symptoms: My asthma

Release 9 — day 0, dose 2

2021-09-10

Systemic reaction (other): My Dr. had me take hydroxyzine pam 1 hour before my Second vaccination to prevent the mild allergic reaction I had last time so far so good. Its been five hours since I took the shot.

Release 9 — days 1–6 daily, dose 2

2021-09-11

Systemic reaction (other): Shortness of breath/wheezing.

2021-09-12

Systemic reaction (other): Shortness of breath

2021-09-14

Systemic reaction (other): Just for tea and a little bit of dizziness

2021-09-15

Systemic reaction (other): Still messing with my asthma a little bit and not having normal energy levels return

2021-09-16

Systemic reaction (other): A little bit of fatigue but feeling better mainly still dealing with triggered asthma cough

Release 9 — day 7, dose 2

2021-09-17

Systemic reaction (other): Fatigue is almost gone and whats left may be related to triggered asthma.

Release 10 — day 35, dose 2

2021-10-15

Symptoms: I did have a similar struggle with my asthma that I had to my first vaccine that I had a allergic reaction to but it didn't last that long.

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	Asthma	✓	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Unevaluable event	·	·	✓
SD	Vaccine positive rechallenge	·	·	✓
SRO	Asthenia	✓	·	✓
SRO	Asthma	·	·	✓
SRO	Cough variant asthma	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Dry mouth	✓	·	✓
SRO	Dyspnoea	✓	·	✓
SRO	Fatigue	·	·	✓
SRO	Hypersensitivity	✓	·	✓
SRO	Hypoaesthesia	✓	·	✓
SRO	Immediate post-injection reaction	✓	·	✓
SRO	Immunisation reaction	·	·	✓
SRO	Office visit	✓	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Respiratory arrest	✓	·	✓
SRO	Wheezing	·	·	✓

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