Z9R-14479-04995

4 vaccinations 7 coded responses 52 check-ins 6 free-text entries 2 call cases

Sex: Male
Age at first dose: 41-45
ZIP prefix: 560 / MN
Registered: 2021-03-31

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

2021-03-31
Registered in v-safe
2021-03-31
Dose 1 — Moderna
2021-03-31
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

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

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Muscle or body aches

Adult check-in
2021-04-07
Survey response — day 7, dose 1
MedDRA: Palpitations — Feeling: Fair · Muscle or body aches

Free text: Palpitations

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — day 14, dose 1
MedDRA: Anxiety, Condition aggravated — Feeling: Fair

Free text: Worsening generalized anxiety, probably not vaccine related.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-28
Dose 2 — Moderna
2021-04-28
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-29
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Injection site erythema, Pain of skin — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work

Free text: Middle back pain (mild), skin hypersensitive to touch (mild), redness by the injection site but only where the adhesive of the bandaid was... (mild)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

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

Adult check-in
2021-05-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-28
Survey response — 3 months, dose 2
MedDRA: Abdominal discomfort, Myalgia, Somnolence — Feeling: Good

Free text: Mild stomach upset; mild muscle soreness. Increased drowsiness.Neither seem likely to be linked to the vaccine, in my layman's opinion.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-27
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-07
Dose 3 — Moderna
2021-12-08
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2021-12-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-12-10
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-12-11
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Muscle or body aches

Adult check-in
2021-12-12
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-12-13
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-15
Health check-in — day 7, dose 3
Feeling: Good · Muscle or body aches

Adult check-in
2021-12-21
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-28
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-04
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-13
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-18
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-08
Survey response — 3 months, dose 3
MedDRA: Palpitations — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Change in palpitations

MedDRA releases: 2024-11 · check-in free text available
2022-03-08
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-06-07
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-09-15
Dose 4 — Moderna
Co-administered: Flu
2022-09-15
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-09-16
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-19
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-09-20
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Muscle or body aches

Adult check-in
2022-09-21
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-09-22
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-09-29
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-17
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-20
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-10-27
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-15
Survey response — 3 months, dose 4
MedDRA: Cough, Nasopharyngitis, Pyrexia, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I had a cold last week with fever and coughing for about 4-5 days. A rapid covid test at home was negative (taken when symptoms started). It's all resolved again now.

MedDRA releases: 2024-11 · check-in free text available
2023-03-16
Survey response — 6 months, dose 4
MedDRA: Eczema, Laboratory test abnormal, Rash — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-03-16
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-03-17
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-31	Moderna
2	2021-04-28	Moderna
3	2021-12-07	Moderna	No
4	2022-09-15	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2022-03-08	Successful 2022-03-16	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2023-03-16	Successful 2023-03-17	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 7 — day 7, dose 1

2021-04-07

Systemic reaction (other): Palpitations

Release 7 — day 14, dose 1

2021-04-14

Symptoms: Worsening generalized anxiety, probably not vaccine related.

Release 8 — days 1–6 daily, dose 2

2021-04-29

Systemic reaction (other): Middle back pain (mild), skin hypersensitive to touch (mild), redness by the injection site but only where the adhesive of the bandaid was... (mild)

Release 9 — 3 months, dose 2

2021-07-28

Symptoms: Mild stomach upset; mild muscle soreness. Increased drowsiness.Neither seem likely to be linked to the vaccine, in my layman's opinion.

Release 11 — 3 months, dose 3

2022-03-08

Symptoms: Change in palpitations

Release 12 — 3 months, dose 4

2022-12-15

Symptoms: I had a cold last week with fever and coughing for about 4-5 days. A rapid covid test at home was negative (taken when symptoms started). It's all resolved again now.

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	Abdominal discomfort	✓	·	✓
SD	Anxiety	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Cough	·	·	✓
SD	Eczema	·	·	✓
SD	Laboratory test abnormal	·	·	✓
SD	Myalgia	✓	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Palpitations	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rash	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Somnolence	✓	·	✓
SRO	Back pain	✓	✓	✓
SRO	Injection site erythema	✓	✓	✓
SRO	Pain of skin	✓	✓	✓
SRO	Palpitations	✓	✓	✓

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