ZNN-21458-62276

2 vaccinations 5 coded responses 24 check-ins 5 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 954 / CA
Registered: 2021-02-09

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

2021-02-09
Registered in v-safe
2021-02-09
Dose 1 — Moderna
2021-02-09
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Good

Free text: Slightly Light headed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Good · Fatigue or tiredness

Free text: Very mild dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-23
Survey response — day 14, dose 1
MedDRA: Asthenia, Ear pain, Feeding disorder, Headache, Injection site pain, Nausea, Pyrexia — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Yesterday I began feeling feverish, my left arm finally hurts at injection site, my stomach is nauseous, I have a headache that comes and goes, painful earache, I can barely eat or drink, and low energy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — day 21, dose 1
MedDRA: Hypersensitivity, Transient ischaemic attack — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Im experiencing allergy type symptoms. Also still recovering from a TIA I had last week.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-09
Dose 2 — Moderna
2021-03-09
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Fatigue or tiredness

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Fatigue or tiredness

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-16
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-06
Survey response — day 28, dose 2
MedDRA: Condition aggravated, Gastric haemorrhage, Hospitalisation, Pre-existing disease — 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, Emergency room or emergency department visit, Hospitalization

Free text: I had to go in the hospital on the first for a bleeding stomach. I have inclusion body myositis and thats gotten very much worse in my arms with my two covid shots period of time at least.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-13
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-20
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-12-13
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-03-09
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Moderna
2	2021-03-09	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-03	Successful	Reported to VAERS voluntarily prior to GDIT contact
2021-04-06	Successful 2021-12-13	Reported to VAERS voluntarily prior to GDIT contact

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Slightly Light headed

2021-02-11

Systemic reaction (other): Very mild dizziness

Release 4 — day 14, dose 1

2021-02-23

Symptoms: Yesterday I began feeling feverish, my left arm finally hurts at injection site, my stomach is nauseous, I have a headache that comes and goes, painful earache, I can barely eat or drink, and low energy.

Release 5 — day 21, dose 1

2021-03-03

Symptoms: Im experiencing allergy type symptoms. Also still recovering from a TIA I had last week.

Release 7 — day 28, dose 2

2021-04-06

Symptoms: I had to go in the hospital on the first for a bleeding stomach. I have inclusion body myositis and thats gotten very much worse in my arms with my two covid shots period of time at least.

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	Asthenia	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Ear pain	✓	✓	✓
SD	Feeding disorder	✓	✓	✓
SD	Gastric haemorrhage	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Transient ischaemic attack	✓	✓	✓
SRO	Dizziness	✓	✓	✓

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