ZSN-20756-18482

2 vaccinations 7 coded responses 19 check-ins 7 free-text entries 4 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 070 / NJ
Registered: 2021-01-23

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

2021-01-23
Registered in v-safe
2021-01-23
Dose 1 — Moderna
2021-01-23
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-24
Survey response — days 1–6 daily, dose 1
MedDRA: Sinus pain — Feeling: Good · Site: Pain

Free text: Sinus pain, mild

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Chills, Fatigue or tiredness

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling cold — Feeling: Good · Site: Itching · Fatigue or tiredness

Free text: Felt cold for second day, but no chills

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — days 1–6 daily, dose 1
MedDRA: Paranasal sinus discomfort — Feeling: Good · Site: Itching · Fatigue or tiredness

Free text: Sinus pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-01-30
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-06
Survey response — day 14, dose 1
MedDRA: Ear infection, Hypertension, Nasopharyngitis, Oropharyngeal pain, Viral infection — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Had either a cold or a virus...Not Covid-19. Sore throat, ear infection, high blood pressure. Dr. treating with antibiotics and Steloto inhaler.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-20
Dose 2 — Moderna
2021-02-27
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-03-06
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-13
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-20
Survey response — day 28, dose 2
MedDRA: Phlebitis, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Phlebitis in right leg. History of blood clots in legs.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-27
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-03
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-24
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-14
Call 1 — Could Not Reach Participant
2021-08-21
Survey response — 6 months, dose 2
MedDRA: Cardiac disorder — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Related to heart issues, not Covid. · Healthcare visit (other): Heart related issues

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-21
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-24
Call 1 — Could Not Reach Participant
2021-08-27
Call 2 — Could Not Reach Participant
2022-02-20
Survey response — 12 months, dose 2
MedDRA: COVID-19, Office visit, SARS-CoV-2 test negative — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Tested negative several times, but had Covid symptoms per our doctor for several weeks. Dr. says my wife and I had mild case of Covid. · Healthcare visit (other): Dr visit face to face several times.

MedDRA releases: 2024-11 · check-in free text available
2022-02-20
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2022-02-23
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-23	Moderna
2	2021-02-20	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-02-06	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-03-20	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-21	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-02-20	Successful 2022-02-23	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-24

Systemic reaction (other): Sinus pain, mild

2021-01-27

Systemic reaction (other): Felt cold for second day, but no chills

2021-01-28

Systemic reaction (other): Sinus pressure

Release 3 — day 14, dose 1

2021-02-06

Symptoms: Had either a cold or a virus...Not Covid-19. Sore throat, ear infection, high blood pressure. Dr. treating with antibiotics and Steloto inhaler.

Release 6 — day 28, dose 2

2021-03-20

Symptoms: Phlebitis in right leg. History of blood clots in legs.

Release 9 — 6 months, dose 2

2021-08-21

Symptoms: Related to heart issues, not Covid.

Healthcare visit (other): Heart related issues

Release 11 — 12 months, dose 2

2022-02-20

Symptoms: Tested negative several times, but had Covid symptoms per our doctor for several weeks. Dr. says my wife and I had mild case of Covid.

Healthcare visit (other): Dr visit face to face several times.

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	Cardiac disorder	✓	·	✓
HCVO	Office visit	·	·	✓
SD	Cardiac disorder	✓	·	✓
SD	COVID-19	·	·	✓
SD	Ear infection	✓	✓	✓
SD	Hypertension	✓	✓	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Office visit	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Phlebitis	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Viral infection	✓	✓	✓
SRO	Feeling cold	✓	✓	✓
SRO	Paranasal sinus discomfort	✓	✓	✓
SRO	Sinus pain	✓	✓	✓

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