ZJY-27591-14970

3 vaccinations 10 coded responses 16 check-ins 10 free-text entries 1 call case

Sex: Male
Age at first dose: 51-55
ZIP prefix: 020 / MA
Registered: 2021-11-19

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

2021-03-12
Dose 1 — Moderna
2021-04-09
Dose 2 — Moderna
2021-11-19
Registered in v-safe
2021-11-19
Dose 3 — Moderna
2021-11-19
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain, Swelling · Diarrhea, Abdominal pain · Be unable to work or attend school

Adult check-in
2021-11-20
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I have a cough

MedDRA releases: 2024-11 · check-in free text available
2021-11-21
Survey response — days 1–6 daily, dose 3
MedDRA: Adverse reaction — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school

Free text: The symptoms were pretty strong last night but much better today

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — Feeling: Fair · Fever · Chills, Headache, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school

Free text: Cough

MedDRA releases: 2024-11 · check-in free text available
2021-11-23
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — Feeling: Good · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: I have a cough

MedDRA releases: 2024-11 · check-in free text available
2021-11-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-11-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-26
Survey response — day 7, dose 3
MedDRA: Dysgeusia — Feeling: Good

Free text: Past couple of days I have had a funny taste in my mouth

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-10
Survey response — day 21, dose 3
MedDRA: Erythema, Pruritus — Feeling: Good

Free text: My toes are red and itchy

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Survey response — day 28, dose 3
MedDRA: Cough, Unevaluable event — Feeling: Good

Free text: Cough and toes still bad

MedDRA releases: 2024-11 · check-in free text available
2021-12-24
Survey response — day 35, dose 3
MedDRA: Erythema, Pain in extremity, Peripheral swelling — Feeling: Good · Be unable to do your normal daily activities

Free text: My toes are not only red and swollen but they hurt.

MedDRA releases: 2024-11 · check-in free text available
2021-12-31
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-18
Survey response — 3 months, dose 3
MedDRA: COVID-19, Fatigue, Hypersomnia — Feeling: Fair

Free text: I am tired, sleeping much more, but I had Covid

MedDRA releases: 2024-11 · check-in free text available
2022-05-20
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-19
Survey response — 12 months, dose 3
MedDRA: Angina pectoris, COVID-19, Diarrhoea, Dyspnoea, Fatigue, Office visit — Feeling: Good · Be unable to work or attend school, 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: Symptoms: Heart pain. Shortness of breath extreme fatigue after Covid in July (2nd time). Diarrhea for months. · Healthcare visit (other): Visited pcp and got ekg, echo cardiogram and appointment with cardiologist

MedDRA releases: 2024-11 · check-in free text available
2022-11-19
Report sent to call center — 12 months, 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-11-21
Call 1 — Requested Callback
2022-11-23
Call 2 — Left Voicemail
2022-11-23
Callback requested for
2022-11-23
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	2021-03-12	Moderna	No
2	2021-04-09	Moderna	No
3	2021-11-19	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-11-19	Successful 2022-11-23	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 10 — days 1–6 daily, dose 3

2021-11-20

Systemic reaction (other): I have a cough

2021-11-21

Systemic reaction (other): The symptoms were pretty strong last night but much better today

2021-11-22

Systemic reaction (other): Cough

2021-11-23

Systemic reaction (other): I have a cough

Release 10 — day 7, dose 3

2021-11-26

Systemic reaction (other): Past couple of days I have had a funny taste in my mouth

Release 10 — day 21, dose 3

2021-12-10

Symptoms: My toes are red and itchy

Release 10 — day 28, dose 3

2021-12-17

Symptoms: Cough and toes still bad

Release 10 — day 35, dose 3

2021-12-24

Symptoms: My toes are not only red and swollen but they hurt.

Release 11 — 3 months, dose 3

2022-02-18

Symptoms: I am tired, sleeping much more, but I had Covid

Release 12 — 12 months, dose 3

2022-11-19

Symptoms: Heart pain. Shortness of breath extreme fatigue after Covid in July (2nd time). Diarrhea for months.

Healthcare visit (other): Visited pcp and got ekg, echo cardiogram and appointment with cardiologist

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	Angina pectoris	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Erythema	·	·	✓
SD	Fatigue	·	·	✓
SD	Hypersomnia	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Peripheral swelling	·	·	✓
SD	Pruritus	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Cough	·	·	✓
SRO	Dysgeusia	·	·	✓

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