ZNN-28866-13691

4 vaccinations 11 coded responses 47 check-ins 11 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 334 / FL
Registered: 2021-01-09

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

2021-01-08
Dose 1 — Moderna
2021-01-09
Registered in v-safe
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-15
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-05
Dose 2 — Moderna
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-02-12
Survey response — day 7, dose 2
MedDRA: Diarrhoea — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Loose bowels

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — day 14, dose 2
MedDRA: Diarrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Had very loose bowel movements.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-22
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-08
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-25
Dose 3 — Moderna
Co-administered: Flu
2021-10-25
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-01
Health check-in — day 7, dose 3
Feeling: Fair · Site: Redness, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-08
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-15
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-22
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-11-30
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-06
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-24
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-04-25
Survey response — 6 months, dose 3
MedDRA: Apnoea, Cardiovascular insufficiency, Lipoprotein (a) increased, Office visit, Positive airway pressure therapy, Unevaluable event, Vascular parkinsonism — 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: Symptoms: Vascular parkinsonism diagnosis and lipodemia. Also use of CPAP machine for my diagnosis of APNEA. High Lipoprotein A levels and constricted blood flow in brain. · Healthcare visit (other): In person visit to several health care providers

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Report sent to call center — 6 months, dose 3
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)
2022-04-27
Call 1 — Could Not Reach Participant
2022-05-02
Call 2 — Left Voicemail
2022-05-26
Dose 4 — Moderna
2022-05-27
Survey response — days 1–6 daily, dose 4
MedDRA: Insomnia, Sleep disorder — Feeling: Fair · Site: Pain · Muscle or body aches

Free text: Insomnia woke @2 AM,couldn't get back to sleep until 5:30 AM

MedDRA releases: 2024-11 · check-in free text available
2022-05-28
Survey response — days 1–6 daily, dose 4
MedDRA: Dizziness — Feeling: Fair · Site: Swelling · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Faintness and lightheadedness

MedDRA releases: 2024-11 · check-in free text available
2022-05-29
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Swelling · Nausea · Be unable to do your normal daily activities

Adult check-in
2022-05-30
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-05-31
Survey response — days 1–6 daily, dose 4
MedDRA: Depressed mood — Feeling: Fair · Site: Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Sadness

MedDRA releases: 2024-11 · check-in free text available
2022-06-01
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-06-02
Health check-in — day 7, dose 4
Feeling: Fair · Site: Swelling · Muscle or body aches

Adult check-in
2022-06-11
Survey response — day 14, dose 4
MedDRA: Hospitalisation — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: In hospital for test unrelated to Covid-19 or vaccination.

MedDRA releases: 2024-11 · check-in free text available
2022-06-11
Report sent to call center — day 14, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-06-13
Call 1 — Left Voicemail
2022-06-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-16
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-06-24
Survey response — day 28, dose 4
MedDRA: Myosclerosis, Pain in extremity — Feeling: Fair

Free text: Right arm sore and has a knot -- hard area in the muscle

MedDRA releases: 2024-11 · check-in free text available
2022-07-02
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-07-07
Survey response — day 42, dose 4
MedDRA: Rhinorrhoea — Feeling: Poor · Be unable to do your normal daily activities

Free text: runny nostrils

MedDRA releases: 2024-11 · check-in free text available
2022-08-25
Survey response — 3 months, dose 4
MedDRA: CADASIL, Medical counselling — 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: Symptoms: Diagnosis of CADASIL A RARE GENETIC DISEASE · Healthcare visit (other): Gentic counseling

MedDRA releases: 2024-11 · check-in free text available
2022-08-25
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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-08-26
Call 3 — Left Voicemail
2022-08-26
Call 2 — Left Voicemail
2022-08-26
Call 1 — Left Voicemail
2022-08-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-24
Survey response — 6 months, dose 4
MedDRA: Clavicle fracture, Road traffic accident — Feeling: Fair · 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: Fell off my bike and fracture my clavicle bone.

MedDRA releases: 2024-11 · check-in free text available
2022-11-24
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

Emergency room or emergency department visit · 1 call case(s)
2022-11-25
Call 1 — Left Voicemail
2023-05-26
Health check-in — 12 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-08	Moderna
2	2021-02-05	Moderna
3	2021-10-25	Moderna	Flu
4	2022-05-26	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-04-25	Successful 2022-06-13	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-11	Successful 2022-06-13	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-25	Successful 2022-08-26	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-24	Unsuccessful

Free text

Release 4 — day 7, dose 2

2021-02-12

Systemic reaction (other): Loose bowels

Release 4 — day 14, dose 2

2021-02-19

Symptoms: Had very loose bowel movements.

Release 11 — 6 months, dose 3

2022-04-25

Symptoms: Vascular parkinsonism diagnosis and lipodemia. Also use of CPAP machine for my diagnosis of APNEA. High Lipoprotein A levels and constricted blood flow in brain.

Healthcare visit (other): In person visit to several health care providers

Release 11 — days 1–6 daily, dose 4

2022-05-27

Systemic reaction (other): Insomnia woke @2 AM,couldn't get back to sleep until 5:30 AM

2022-05-28

Systemic reaction (other): Faintness and lightheadedness

2022-05-31

Systemic reaction (other): Sadness

Release 12 — day 14, dose 4

2022-06-11

Symptoms: In hospital for test unrelated to Covid-19 or vaccination.

Release 12 — day 28, dose 4

2022-06-24

Symptoms: Right arm sore and has a knot -- hard area in the muscle

Release 12 — day 42, dose 4

2022-07-07

Symptoms: runny nostrils

Release 12 — 3 months, dose 4

2022-08-25

Symptoms: Diagnosis of CADASIL A RARE GENETIC DISEASE

Healthcare visit (other): Gentic counseling

Release 12 — 6 months, dose 4

2022-11-24

Symptoms: Fell off my bike and fracture my clavicle bone.

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	Office visit	·	·	✓
SD	Apnoea	·	·	✓
SD	CADASIL	·	·	✓
SD	Cardiovascular insufficiency	·	·	✓
SD	Clavicle fracture	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Hospitalisation	·	·	✓
SD	Lipoprotein (a) increased	·	·	✓
SD	Myosclerosis	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Positive airway pressure therapy	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Road traffic accident	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Vascular parkinsonism	·	·	✓
SRO	Depressed mood	·	·	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Dizziness	·	·	✓
SRO	Insomnia	·	·	✓
SRO	Sleep disorder	·	·	✓

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