ZJL-28306-75110

4 vaccinations 13 coded responses 32 check-ins 13 free-text entries 3 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 140 / NY
Registered: 2021-03-17

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

2021-02-16
Dose 1 — Moderna
2021-03-16
Dose 2 — Moderna
2021-03-17
Registered in v-safe
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2021-03-19
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue, Headache — Feeling: Good · Headache, Fatigue or tiredness

Free text: Vague head ache and tired. I am much improved.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Fatigue or tiredness, Nausea

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-23
Survey response — day 7, dose 2
MedDRA: Fatigue, Headache — Feeling: Good · Headache, Fatigue or tiredness

Free text: Some days ok. The next head ache and tired..

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-06
Survey response — day 21, dose 2
MedDRA: Dyspnoea, Pre-existing disease — Feeling: Good

Free text: At times I am short of breath. Note: I have COPD and did not associate it w/ vaccination. Though thinking back the SOB Id more than my normal.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — day 28, dose 2
MedDRA: Dyspnoea — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Short of breath. Now taking 2rd course of prednisone. 50 mg per day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-22
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-27
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-15
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-14
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-09-16
Dose 3 — Moderna
2021-10-28
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-16
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-20
Call 1 — Left Voicemail
2022-03-17
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-19
Dose 4 — Moderna
2022-04-20
Survey response — days 1–6 daily, dose 4
MedDRA: Sluggishness — Feeling: Good · Site: Pain · Muscle or body aches

Free text: A bit sluggish. But I am ok.

MedDRA releases: 2024-11 · check-in free text available
2022-04-21
Survey response — days 1–6 daily, dose 4
MedDRA: Body temperature increased, Eye irritation, Myalgia — Feeling: Good

Free text: Yesterday I had a 100.2 temp as well as muscle aches and scratchy eyes. Today I have no side effects and am my usual self.

MedDRA releases: 2024-11 · check-in free text available
2022-04-22
Survey response — days 1–6 daily, dose 4
MedDRA: No adverse event — Feeling: Good

Free text: I'm doing fine. In the garden planting!

MedDRA releases: 2024-11 · check-in free text available
2022-04-23
Survey response — days 1–6 daily, dose 4
MedDRA: No adverse event — Feeling: Good

Free text: Nothing to report. I am my usual happy self! :-)

MedDRA releases: 2024-11 · check-in free text available
2022-04-24
Survey response — days 1–6 daily, dose 4
MedDRA: Unevaluable event — Feeling: Good

Free text: I'm swell today. Back out in the garden!

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Survey response — days 1–6 daily, dose 4
MedDRA: No adverse event — Feeling: Good

Free text: None for today, I'm fine!

MedDRA releases: 2024-11 · check-in free text available
2022-04-26
Survey response — day 7, dose 4
MedDRA: No adverse event — Feeling: Good

Free text: None. I'm my usual self. :-)

MedDRA releases: 2024-11 · check-in free text available
2022-05-03
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-10
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-02
Survey response — day 42, dose 4
MedDRA: Exposure to SARS-CoV-2, Pre-existing disease, Productive cough, Quarantine, SARS-CoV-2 test negative, SARS-CoV-2 test positive — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Symptoms: My wife and I are on a cruise in (b)(6). 5 days ago she tested positive for COVID. In quarantined. Starting with the day my wife tested positive I have been neg. Until today. I have COPD,2 days ago prod. Cough. Taking 50 prednisone for 6 days. · Healthcare visit (other): Quarantine onboard ship.

MedDRA releases: 2024-11 · check-in free text available
2022-06-02
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-06-03
Call 2 — Left Voicemail
2022-06-03
Call 1 — Left Voicemail
2022-07-19
Survey response — 3 months, dose 4
MedDRA: Cough, Dyspnoea, Dyspnoea exertional, Exercise tolerance decreased, Insomnia, Medical counselling, Rhinorrhoea — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: SOB when walking. Decreased exercise tolerance. Run out of air when speaking. At times difficulty sleeping. Harsh cough. Increased nasal secretions. · Healthcare visit (other): Contacted physician

MedDRA releases: 2024-11 · check-in free text available
2022-07-19
Report sent to call center — 3 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-07-20
Call 1 — Left Voicemail
2022-10-18
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2023-04-19
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-16	Moderna
2	2021-03-16	Moderna
3	2021-09-16	Moderna	No
4	2022-04-19	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-13	Unsuccessful
2022-06-02	Unsuccessful
2022-07-19	Unsuccessful

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-19

Systemic reaction (other): Vague head ache and tired. I am much improved.

Release 6 — day 7, dose 2

2021-03-23

Systemic reaction (other): Some days ok. The next head ache and tired..

Release 7 — day 21, dose 2

2021-04-06

Symptoms: At times I am short of breath. Note: I have COPD and did not associate it w/ vaccination. Though thinking back the SOB Id more than my normal.

Release 7 — day 28, dose 2

2021-04-13

Symptoms: Short of breath. Now taking 2rd course of prednisone. 50 mg per day.

Release 11 — days 1–6 daily, dose 4

2022-04-20

Systemic reaction (other): A bit sluggish. But I am ok.

2022-04-21

Systemic reaction (other): Yesterday I had a 100.2 temp as well as muscle aches and scratchy eyes. Today I have no side effects and am my usual self.

2022-04-22

Systemic reaction (other): I'm doing fine. In the garden planting!

2022-04-23

Systemic reaction (other): Nothing to report. I am my usual happy self! :-)

2022-04-24

Systemic reaction (other): I'm swell today. Back out in the garden!

2022-04-25

Systemic reaction (other): None for today, I'm fine!

Release 11 — day 7, dose 4

2022-04-26

Systemic reaction (other): None. I'm my usual self. :-)

Release 11 — day 42, dose 4

2022-06-02

Symptoms: My wife and I are on a cruise in (b)(6). 5 days ago she tested positive for COVID. In quarantined. Starting with the day my wife tested positive I have been neg. Until today. I have COPD,2 days ago prod. Cough. Taking 50 prednisone for 6 days.

Healthcare visit (other): Quarantine onboard ship.

redacted (b)(6)

Release 12 — 3 months, dose 4

2022-07-19

Symptoms: SOB when walking. Decreased exercise tolerance. Run out of air when speaking. At times difficulty sleeping. Harsh cough. Increased nasal secretions.

Healthcare visit (other): Contacted physician

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	Medical counselling	·	·	✓
HCVO	Quarantine	·	·	✓
SD	Cough	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Dyspnoea exertional	·	·	✓
SD	Exercise tolerance decreased	·	·	✓
SD	Exposure to SARS-CoV-2	·	·	✓
SD	Insomnia	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Productive cough	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SRO	Body temperature increased	·	·	✓
SRO	Eye irritation	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Myalgia	·	·	✓
SRO	No adverse event	·	·	✓
SRO	Sluggishness	·	·	✓
SRO	Unevaluable event	·	·	✓

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