ZK9-21311-51522

3 vaccinations 9 coded responses 12 check-ins 9 free-text entries 2 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 907 / CA
Registered: 2022-01-10

Relationship: Self
Race: Asian
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-05-10
Dose 1 — Moderna
2021-06-12
Dose 2 — Moderna
2022-01-07
Dose 3 — Moderna
2022-01-10
Registered in v-safe
2022-01-10
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Nasopharyngitis, Physiotherapy, Throat irritation — Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Cough, colds, ithcy throat · Healthcare visit (other): Physical therapy visit at 8am

MedDRA releases: 2024-11 · check-in free text available
2022-01-10
Report sent to call center — days 1–6 daily, 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

1 call case(s)
2022-01-11
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Nasopharyngitis, Ocular hyperaemia, Oropharyngeal pain, Throat irritation — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Colds, cough, sore and itchy throat, eyes redness

MedDRA releases: 2024-11 · check-in free text available
2022-01-12
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Nasopharyngitis, Ocular hyperaemia, Unevaluable event — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Red eyes, cough, colds, · Healthcare visit (other): Therapy

MedDRA releases: 2024-11 · check-in free text available
2022-01-12
Report sent to call center — days 1–6 daily, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-01-13
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Nasopharyngitis, Ocular hyperaemia, Oropharyngeal pain, Throat irritation — Feeling: Poor · Fever · Chills, Headache, Fatigue or tiredness

Free text: Cough, colds, itchy/sore throat and red eyes

MedDRA releases: 2024-11 · check-in free text available
2022-01-14
Survey response — day 7, dose 3
MedDRA: Cough, Nasopharyngitis, Oropharyngeal pain — Feeling: Fair · Fever · Headache, Fatigue or tiredness, Abdominal pain

Free text: Mild cough due to sore throat, colds

MedDRA releases: 2024-11 · check-in free text available
2022-01-14
Call 1 — Could Not Reach Participant
2022-01-20
Call 2 — Could Not Reach Participant
2022-01-21
Survey response — day 14, dose 3
MedDRA: Fatigue, Respiratory disorder — Feeling: Poor · Be unable to do your normal daily activities

Free text: I'm getting tired faster. And problem in breathing.

MedDRA releases: 2024-11 · check-in free text available
2022-01-28
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-02-04
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-11
Survey response — day 35, dose 3
MedDRA: Body temperature increased — Feeling: Good

Free text: I felt my body temperature is going up in last four (4) nights.

MedDRA releases: 2024-11 · check-in free text available
2022-02-18
Survey response — day 42, dose 3
MedDRA: Cough, Nasopharyngitis — Feeling: Good

Free text: Colds and mild cough

MedDRA releases: 2024-11 · check-in free text available
2022-04-08
Survey response — 3 months, dose 3
MedDRA: Abnormal sensation in eye, Dry throat, Headache, Visual impairment — Feeling: Poor · Be unable to do your normal daily activities

Free text: Headache, dry throat, body heat coming out my eyes , poor eye sight.

MedDRA releases: 2024-11 · check-in free text available
2023-01-07
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-10	Moderna	No
2	2021-06-12	Moderna	No
3	2022-01-07	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-01-10	Unsuccessful
2022-01-12	Unsuccessful

Free text

Release 10 — days 1–6 daily, dose 3

2022-01-10

Systemic reaction (other): Cough, colds, ithcy throat

Healthcare visit (other): Physical therapy visit at 8am

2022-01-11

Systemic reaction (other): Colds, cough, sore and itchy throat, eyes redness

2022-01-12

Systemic reaction (other): Red eyes, cough, colds,

Healthcare visit (other): Therapy

2022-01-13

Systemic reaction (other): Cough, colds, itchy/sore throat and red eyes

Release 10 — day 7, dose 3

2022-01-14

Systemic reaction (other): Mild cough due to sore throat, colds

Release 11 — day 14, dose 3

2022-01-21

Symptoms: I'm getting tired faster. And problem in breathing.

Release 11 — day 35, dose 3

2022-02-11

Symptoms: I felt my body temperature is going up in last four (4) nights.

Release 11 — day 42, dose 3

2022-02-18

Symptoms: Colds and mild cough

Release 11 — 3 months, dose 3

2022-04-08

Symptoms: Headache, dry throat, body heat coming out my eyes , poor eye sight.

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	Physiotherapy	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Abnormal sensation in eye	·	·	✓
SD	Body temperature increased	·	·	✓
SD	Cough	·	·	✓
SD	Dry throat	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Respiratory disorder	·	·	✓
SD	Visual impairment	·	·	✓
SRO	Cough	·	·	✓
SRO	Nasopharyngitis	·	·	✓
SRO	Ocular hyperaemia	·	·	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Throat irritation	·	·	✓

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