Z9P-19400-87181

3 vaccinations 10 coded responses 36 check-ins 10 free-text entries 5 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 452 / OH
Registered: 2021-01-11

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

2021-01-11
Registered in v-safe
2021-01-11
Dose 1 — Moderna
2021-01-11
Survey response — day 0, dose 1
MedDRA: Hypoaesthesia oral — Feeling: Good

Free text: My lips seem a little Numb

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fever · Headache

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Survey response — day 14, dose 1
MedDRA: Adverse reaction — Feeling: Good · 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, Emergency room or emergency department visit

Free text: I had a stent placed in my Circumflex coronary artery. This is not related and scheduled before I had the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — day 14, 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)
2021-02-01
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-08
Survey response — day 28, dose 1
MedDRA: Pre-existing disease, Rhinorrhoea, Sneezing — Feeling: Good

Free text: Sneezing and a running nose that is consistent with allergies I have.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Dose 2 — Moderna
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-02-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-04
Survey response — day 21, dose 2
MedDRA: Chest discomfort, Dyspnoea, Head discomfort, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: I have head chest discomfort and shortness of breath. This is probably not related to the Vaccine, the symptoms precededVaccine, but they have worsened in the last week. · Healthcare visit (other): In person doctor visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-13
Survey response — 3 months, dose 2
MedDRA: Dizziness, Heart rate abnormal — Feeling: Good · 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: My heart rate fail to 140 And I experienced lightheadedness. My doctor change my medications and I am fine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
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)
2021-06-09
Call successful
Participant prefers to complete VAERS report online
2021-08-14
Survey response — 6 months, dose 2
MedDRA: Tenosynovitis stenosans — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: De Quervain's tenosynovitis, right

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-14
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-18
Call 1 — Left Voicemail
2021-10-26
Dose 3 — Moderna
2021-10-26
Health check-in — day 0, dose 3
Feeling: Good · None · Be unable to do your normal daily activities

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Gait disturbance, Myalgia — Feeling: Good · Site: Pain

Free text: Muscle pain in right thigh that sometimes results in a noticeable limp.

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Myalgia — Feeling: Good · Muscle or body aches

Free text: Sore thigh mussel

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-02
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-09
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-18
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-23
Survey response — day 28, dose 3
MedDRA: Cough, Nasal congestion — Feeling: Fair

Free text: Nasal congestion and cough

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Survey response — day 35, dose 3
MedDRA: Cough, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Frequent coughing · Healthcare visit (other): Doctor appointment

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

1 call case(s)
2021-12-06
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-04-26
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-26
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-11	Moderna
2	2021-02-11	Moderna
3	2021-10-26	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-27	Successful 2021-06-09	Participant prefers to complete VAERS report online
2021-03-04	Successful	Participant prefers to complete VAERS report online
2021-05-13	Successful	Participant prefers to complete VAERS report online
2021-08-14	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-03	Successful 2021-12-06	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 1 — day 0, dose 1

2021-01-11

Systemic reaction (other): My lips seem a little Numb

Release 2 — day 14, dose 1

2021-01-27

Symptoms: I had a stent placed in my Circumflex coronary artery. This is not related and scheduled before I had the vaccine.

Release 3 — day 28, dose 1

2021-02-08

Symptoms: Sneezing and a running nose that is consistent with allergies I have.

Release 5 — day 21, dose 2

2021-03-04

Symptoms: I have head chest discomfort and shortness of breath. This is probably not related to the Vaccine, the symptoms precededVaccine, but they have worsened in the last week.

Healthcare visit (other): In person doctor visit

Release 8 — 3 months, dose 2

2021-05-13

Symptoms: My heart rate fail to 140 And I experienced lightheadedness. My doctor change my medications and I am fine.

Release 9 — 6 months, dose 2

2021-08-14

Symptoms: De Quervain's tenosynovitis, right

Release 10 — days 1–6 daily, dose 3

2021-10-29

Systemic reaction (other): Muscle pain in right thigh that sometimes results in a noticeable limp.

2021-10-30

Systemic reaction (other): Sore thigh mussel

Release 10 — day 28, dose 3

2021-11-23

Symptoms: Nasal congestion and cough

Release 10 — day 35, dose 3

2021-12-03

Symptoms: Frequent coughing

Healthcare visit (other): Doctor appointment

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	Adverse reaction	✓	✓	✓
SD	Chest discomfort	✓	✓	✓
SD	Cough	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Head discomfort	✓	✓	✓
SD	Heart rate abnormal	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Sneezing	✓	✓	✓
SD	Tenosynovitis stenosans	✓	·	✓
SRO	Gait disturbance	·	·	✓
SRO	Hypoaesthesia oral	✓	✓	✓
SRO	Myalgia	·	·	✓

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