ZU4-25438-53902

4 vaccinations 10 coded responses 40 check-ins 10 free-text entries 4 call cases

Sex: Male
Age at first dose: 46-50
ZIP prefix: 900 / CA
Registered: 2021-03-08

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-03-08
Registered in v-safe
2021-03-08
Dose 1 — Moderna
2021-03-08
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-11
Survey response — days 1–6 daily, dose 1
MedDRA: Back disorder, Gastrointestinal disorder — Feeling: Good · Muscle or body aches, Abdominal pain

Free text: Right side of my abdomen and lower back have been out of wack since the injection but not sure if its because of the injection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal pain, Back pain — Feeling: Good · Abdominal pain

Free text: Slight abdominal pain in right side and lower right back.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches, Abdominal pain

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches, Abdominal pain

Adult check-in
2021-03-15
Health check-in — day 7, dose 1
Feeling: Good · Abdominal pain

Adult check-in
2021-03-22
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-05
Dose 2 — Moderna
2021-06-07
Survey response — 3 months, dose 1
MedDRA: Chills, Constipation, Diarrhoea, Pain, Sinusitis — Feeling: Poor · Be unable to work, 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: Constantly dealing with a never ending sinus infection. Aches, pains, chills, diarrhea AND constipation,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-07
Report sent to call center — 3 months, dose 1
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)
2021-09-06
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2021-10-29
Dose 3 — Moderna
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Itching · Muscle or body aches

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-05
Survey response — day 7, dose 3
MedDRA: Night sweats — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Night sweats

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Call 1 — Could Not Reach Participant
2021-11-12
Survey response — day 14, dose 3
MedDRA: Productive cough — Feeling: Fair

Free text: Huge phlegm build up. I've been coughing it all up since Monday.

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Call 2 — Could Not Reach Participant
2021-11-19
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-26
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-03
Survey response — day 35, dose 3
MedDRA: Asthma, Pre-existing disease, Reaction to previous exposure to any vaccine, Vision blurred, Visual impairment — Feeling: Fair

Free text: Vision has been off and blurry and my asthma has been bad as of late and I can't seem to rid myself of the phlegm in my lungs from the initial booster shot.

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-28
Survey response — 3 months, dose 3
MedDRA: Chest pain, Pain in extremity — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Pain in my left arm and chest pain on my left side. Really sharp pain.

MedDRA releases: 2024-11 · check-in free text available
2022-01-28
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-02
Call 1 — Left Voicemail
2022-04-29
Survey response — 6 months, dose 3
MedDRA: Decreased appetite, Influenza, Insomnia, Pain — 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 · Telehealth, virtual health, or email health consultation

Free text: Felt like I caught Covid it was a bad flu for 3 days. Aches, pains lack of sleep and loss appetite

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Report sent to call center — 6 months, 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-05-04
Call 1 — Left Voicemail
2022-07-29
Dose 4 — Moderna
2022-07-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Abdominal pain

Adult check-in
2022-07-31
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Swelling · Muscle or body aches

Adult check-in
2022-08-01
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Muscle or body aches

Adult check-in
2022-08-02
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2022-08-03
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Muscle or body aches

Adult check-in
2022-08-04
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Muscle or body aches

Adult check-in
2022-08-05
Health check-in — day 7, dose 4
Feeling: Good · Muscle or body aches

Adult check-in
2022-08-12
Survey response — day 14, dose 4
MedDRA: Back pain, Pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Body aches and lower back pain

MedDRA releases: 2024-11 · check-in free text available
2022-08-20
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-08-26
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-09-02
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-09-09
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-10-28
Survey response — 3 months, dose 4
MedDRA: Migraine, Pain, Sinus disorder — 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

Free text: Constant sinus migraines and aches all over my body.

MedDRA releases: 2024-11 · check-in free text available
2022-10-28
Report sent to call center — 3 months, 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-11-01
Call successful
Does not wish to fill out VAERS report
2022-11-01
Call successful
Does not wish to fill out VAERS report
2022-11-01
Call successful
Does not wish to fill out VAERS report
2022-11-01
Call successful
Does not wish to fill out VAERS report
2023-01-27
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-08	Moderna
2	2021-04-05	Moderna	No
3	2021-10-29	Moderna	No
4	2022-07-29	Moderna	No

Call center

4 call center cases

4 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-11

Systemic reaction (other): Right side of my abdomen and lower back have been out of wack since the injection but not sure if its because of the injection.

2021-03-12

Systemic reaction (other): Slight abdominal pain in right side and lower right back.

Release 8 — 3 months, dose 1

2021-06-07

Symptoms: Constantly dealing with a never ending sinus infection. Aches, pains, chills, diarrhea AND constipation,

Release 10 — day 7, dose 3

2021-11-05

Systemic reaction (other): Night sweats

Release 10 — day 14, dose 3

2021-11-12

Symptoms: Huge phlegm build up. I've been coughing it all up since Monday.

Release 10 — day 35, dose 3

2021-12-03

Symptoms: Vision has been off and blurry and my asthma has been bad as of late and I can't seem to rid myself of the phlegm in my lungs from the initial booster shot.

Release 11 — 3 months, dose 3

2022-01-28

Symptoms: Pain in my left arm and chest pain on my left side. Really sharp pain.

Release 11 — 6 months, dose 3

2022-04-29

Symptoms: Felt like I caught Covid it was a bad flu for 3 days. Aches, pains lack of sleep and loss appetite

Release 12 — day 14, dose 4

2022-08-12

Symptoms: Body aches and lower back pain

Release 12 — 3 months, dose 4

2022-10-28

Symptoms: Constant sinus migraines and aches all over my body.

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	Asthma	·	·	✓
SD	Back pain	·	·	✓
SD	Chest pain	·	·	✓
SD	Chills	✓	✓	✓
SD	Constipation	✓	✓	✓
SD	Decreased appetite	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Influenza	·	·	✓
SD	Insomnia	·	·	✓
SD	Migraine	·	·	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Productive cough	·	·	✓
SD	Reaction to previous exposure to any vaccine	·	·	✓
SD	Sinus disorder	·	·	✓
SD	Sinusitis	✓	✓	✓
SD	Vision blurred	·	·	✓
SD	Visual impairment	·	·	✓
SRO	Abdominal pain	✓	✓	✓
SRO	Back disorder	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Gastrointestinal disorder	✓	✓	✓
SRO	Night sweats	·	·	✓

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