ZPH-34786-54653

2 vaccinations 7 coded responses 15 check-ins 7 free-text entries 6 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 020 / MA
Registered: 2021-04-22

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

2021-03-25
Dose 1 — Moderna
2021-04-22
Registered in v-safe
2021-04-22
Dose 2 — Moderna
2021-04-22
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-04-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-29
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-05-06
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-13
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-20
Survey response — day 28, dose 2
MedDRA: Conjunctivitis, Eye discharge, Eye inflammation, Ocular hyperaemia, Office visit, Pre-existing disease, Self-medication — Feeling: Fair · 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: My eyes are inflammed for 7 days now. Colored discharged from both eyes and redness. I went to urgent care they diadnosed it as conjunctivitis. They prescribed cipro eye drops and over the counter mast cell stabilizer eye drops for allergy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
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)
2021-05-27
Survey response — day 35, dose 2
MedDRA: Conjunctivitis viral, Eye inflammation, Office visit — Feeling: Fair · Be unable to work, 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: Symptoms: Severe inflamation in both eyes ..diagnosed as severe viral conjunctivitis. Visited ophthalmologist this week .Last week visited urgent care. · Healthcare visit (other): Specialist ..ophthalmology

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Report sent to call center — day 35, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-03
Survey response — day 42, dose 2
MedDRA: Condition aggravated, Eye inflammation, Pre-existing disease — Feeling: Fair · Be unable to work, 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: Eye inflammationMy autoimmune condition flared pemphigus

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-03
Report sent to call center — day 42, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-24
Survey response — 3 months, dose 2
MedDRA: Blister, Condition aggravated, Headache, Pain, Pre-existing disease — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: My skin autoimmune condition flared woth blisters . I also had headaches and body aches.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-24
Report sent to call center — 3 months, dose 2
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)
2021-08-02
Call 1 — Left Voicemail
2021-10-26
Survey response — 6 months, dose 2
MedDRA: Condition aggravated, Pre-existing disease — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: My pemphigus vaulgaris flared and i had to recieve rituxan therapy .. This is unusual for me

MedDRA releases: 2024-11 · check-in free text available
2021-10-26
Report sent to call center — 6 months, dose 2
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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-28
Call 1 — Left Voicemail
2022-04-22
Survey response — 12 months, dose 2
MedDRA: Headache, Rhinorrhoea — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Runny nose headaches

MedDRA releases: 2024-11 · check-in free text available
2022-04-22
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-25
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	2021-03-25	Moderna
2	2021-04-22	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-05-20	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-05-27	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-06-03	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-07-24	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-26	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-22	Successful 2022-04-25	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-23

Systemic reaction (other): Sore throat

Release 8 — day 28, dose 2

2021-05-20

Symptoms: My eyes are inflammed for 7 days now. Colored discharged from both eyes and redness. I went to urgent care they diadnosed it as conjunctivitis. They prescribed cipro eye drops and over the counter mast cell stabilizer eye drops for allergy.

Release 8 — day 35, dose 2

2021-05-27

Symptoms: Severe inflamation in both eyes ..diagnosed as severe viral conjunctivitis. Visited ophthalmologist this week .Last week visited urgent care.

Healthcare visit (other): Specialist ..ophthalmology

Release 8 — day 42, dose 2

2021-06-03

Symptoms: Eye inflammationMy autoimmune condition flared pemphigus

Release 9 — 3 months, dose 2

2021-07-24

Symptoms: My skin autoimmune condition flared woth blisters . I also had headaches and body aches.

Release 10 — 6 months, dose 2

2021-10-26

Symptoms: My pemphigus vaulgaris flared and i had to recieve rituxan therapy .. This is unusual for me

Release 11 — 12 months, dose 2

2022-04-22

Symptoms: Runny nose headaches

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	Blister	✓	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Conjunctivitis	✓	✓	✓
SD	Conjunctivitis viral	✓	✓	✓
SD	Eye discharge	✓	✓	✓
SD	Eye inflammation	✓	✓	✓
SD	Headache	✓	·	✓
SD	Ocular hyperaemia	✓	✓	✓
SD	Office visit	✓	✓	✓
SD	Pain	✓	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	Self-medication	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓

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