ZJV-30430-45860

4 vaccinations 10 coded responses 47 check-ins 10 free-text entries 3 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 303 / GA
Registered: 2021-03-20

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

2021-03-19
Dose 1 — Moderna
2021-03-20
Registered in v-safe
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

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

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-03-26
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-02
Survey response — day 14, dose 1
MedDRA: Infection, Injection site erythema, Injection site pain, Injection site swelling — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: 1 week after receivinf rhe vaccine, the injection site became red, swollen and painful. My doctor prescribed an antibiotic due to concerns of an infection. It is better now, and i am still taking the antibiotic.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-09
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-19
Dose 2 — Moderna
2021-04-19
Survey response — day 0, dose 2
MedDRA: Brain fog — Feeling: Fair · Site: Pain

Free text: Brain fog

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

Adult check-in
2021-04-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-26
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-03
Survey response — day 14, dose 2
MedDRA: Oropharyngeal pain — Feeling: Good

Free text: Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-17
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-26
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-31
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-10
Call successful
Participant prefers to complete VAERS report online
2021-10-18
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-02
Dose 3 — Moderna
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness — Feeling: Poor · Site: Pain · Chills, Headache, Fatigue or tiredness, Nausea

Free text: Light headedness

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Nausea, Diarrhea

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness, Diarrhea

Adult check-in
2021-11-09
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-16
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-25
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-30
Survey response — day 28, dose 3
MedDRA: Diarrhoea, Headache, Nausea, Pyrexia — Feeling: Fair · Be unable to work or attend school, 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: Diarrhea, nausea, low grade fever, headache

MedDRA releases: 2024-11 · check-in free text available
2021-11-30
Report sent to call center — day 28, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-03
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-07
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-14
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-01
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-03
Survey response — 6 months, dose 3
MedDRA: Diarrhoea — Feeling: Good

Free text: Diarrhea

MedDRA releases: 2024-11 · check-in free text available
2022-05-24
Dose 4 — Moderna
2022-05-25
Survey response — days 1–6 daily, dose 4
MedDRA: Cough — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Mild cough

MedDRA releases: 2024-11 · check-in free text available
2022-05-26
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling · None

Adult check-in
2022-05-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-31
Survey response — day 7, dose 4
MedDRA: Dizziness — Feeling: Good

Free text: Light headed

MedDRA releases: 2024-11 · check-in free text available
2022-06-07
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-21
Survey response — day 28, dose 4
MedDRA: Cough, Headache, Respiratory tract congestion, Rhinorrhoea — Feeling: Fair

Free text: Headache, cough, runny nose, head congestion

MedDRA releases: 2024-11 · check-in free text available
2022-06-29
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-05
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-23
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-22
Survey response — 6 months, dose 4
MedDRA: Ageusia, Cough, Headache, Oropharyngeal pain, Pain, Respiratory tract congestion — Feeling: Fair · 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: Congestion, cough, headachez sore throatz body aches, loss of taste

MedDRA releases: 2024-11 · check-in free text available
2022-11-22
Report sent to call center — 6 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-11-23
Call 1 — Left Voicemail
2023-05-24
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-19	Moderna
2	2021-04-19	Moderna
3	2021-11-02	Moderna	No
4	2022-05-24	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-02	Successful 2021-06-10	Participant prefers to complete VAERS report online
2021-11-30	Successful 2021-12-03	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-11-22	Unsuccessful

Free text

Release 6 — day 14, dose 1

2021-04-02

Symptoms: 1 week after receivinf rhe vaccine, the injection site became red, swollen and painful. My doctor prescribed an antibiotic due to concerns of an infection. It is better now, and i am still taking the antibiotic.

Release 7 — day 0, dose 2

2021-04-19

Systemic reaction (other): Brain fog

Release 8 — day 14, dose 2

2021-05-03

Symptoms: Sore throat

Release 10 — days 1–6 daily, dose 3

2021-11-03

Systemic reaction (other): Light headedness

Release 10 — day 28, dose 3

2021-11-30

Symptoms: Diarrhea, nausea, low grade fever, headache

Release 11 — 6 months, dose 3

2022-05-03

Symptoms: Diarrhea

Release 11 — days 1–6 daily, dose 4

2022-05-25

Systemic reaction (other): Mild cough

Release 11 — day 7, dose 4

2022-05-31

Systemic reaction (other): Light headed

Release 12 — day 28, dose 4

2022-06-21

Symptoms: Headache, cough, runny nose, head congestion

Release 12 — 6 months, dose 4

2022-11-22

Symptoms: Congestion, cough, headachez sore throatz body aches, loss of taste

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	Ageusia	·	·	✓
SD	Cough	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Headache	·	·	✓
SD	Infection	✓	✓	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Injection site swelling	✓	✓	✓
SD	Nausea	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	·	·	✓
SRO	Brain fog	✓	✓	✓
SRO	Cough	·	·	✓
SRO	Dizziness	·	·	✓

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