3CE-24410-28498

4 vaccinations 11 coded responses 15 check-ins 11 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 101 / NY
Registered: 2021-11-06

Relationship: Self
Race: Asian
Ethnicity: N/A

Timeline

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

2021-01-10
Dose 1 — Moderna
2021-02-13
Dose 2 — Moderna
2021-11-04
Dose 3 — Moderna
2021-11-06
Registered in v-safe
2021-11-06
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness, Tinnitus — Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: lightheadedness and tinnitus

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Survey response — days 1–6 daily, dose 3
MedDRA: Bladder discomfort, Ear discomfort, Reaction to previous exposure to any vaccine, Tinnitus, Unevaluable event, Urine output decreased — Feeling: Fair · Site: Itching · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Onset of tinnitus and fullness in ears. Both similar to experience after #1 does of Moderna on 1/16. Also, some bladder discomfort (sense of bladder fullness but little to no urination) · Healthcare visit (other): Contacting doctors tomorrow to get appointments

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-08
Survey response — days 1–6 daily, dose 3
MedDRA: Ear discomfort, Tinnitus, Unevaluable event — Feeling: Fair · Headache, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Continued tinnitus and full sensation in ears · Healthcare visit (other): Earliest appt available by doctor at end of November

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-09
Survey response — days 1–6 daily, dose 3
MedDRA: Ear discomfort, Tinnitus, Unevaluable event — Feeling: Fair · Joint pains · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Continued tinnitus and fullness in ears · Healthcare visit (other): Testing and doctor visit scheduled for end of month

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-10
Call 1 — Requested Callback
2021-11-10
Callback requested for
03:00PM ET
2021-11-10
Call successful
Participant prefers to complete VAERS report online
2021-11-11
Survey response — day 7, dose 3
MedDRA: Breast tenderness, Ear discomfort, Lymph node pain, Tinnitus, Vaccine positive rechallenge — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Continued tinnitus and fullness in ears and tenderness on the area around breasts, particularly on the right side. Suspect this symptom is related to vaccine impact on lymph nodes. · Healthcare visit (other): These symptoms are same asExperienced with # 1 and #2 Moderna. ENT appointments scheduled for end of November. Will monitor breast/lymph node tenderness

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Report sent to call center — day 7, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-12
Call 1 — Could Not Reach Participant
2021-11-17
Call 2 — Requested Callback
2021-11-17
Callback requested for
2021-11-17
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-18
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-26
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-02-03
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-07
Dose 4 — Moderna
2022-04-10
Survey response — days 1–6 daily, dose 4
MedDRA: Ear discomfort, Tinnitus — Feeling: Fair

Free text: Tinnitus and ear fullness

MedDRA releases: 2024-11 · check-in free text available
2022-04-11
Survey response — days 1–6 daily, dose 4
MedDRA: Ear congestion, Tinnitus — Feeling: Fair · Be unable to do your normal daily activities

Free text: Tinnitus and sensation of ear fullness

MedDRA releases: 2024-11 · check-in free text available
2022-04-12
Survey response — days 1–6 daily, dose 4
MedDRA: Dizziness, Tinnitus — Feeling: Fair · Be unable to do your normal daily activities

Free text: Continued tinnitus and some dizziness

MedDRA releases: 2024-11 · check-in free text available
2022-04-13
Survey response — days 1–6 daily, dose 4
MedDRA: Tinnitus — Feeling: Fair · Headache · Be unable to do your normal daily activities

Free text: Tinnitus

MedDRA releases: 2024-11 · check-in free text available
2022-04-16
Survey response — day 7, dose 4
MedDRA: Tinnitus — Feeling: Fair

Free text: Continued tinnitus

MedDRA releases: 2024-11 · check-in free text available
2022-07-10
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-10-07
Survey response — 6 months, dose 4
MedDRA: Cough, Fatigue, Pain in extremity — Feeling: Fair

Free text: Got Moderna vax yesterday. Usual sore arm and tires but this time slight dry cough as of today

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-10	Moderna	No
2	2021-02-13	Moderna	No
3	2021-11-04	Moderna	No
4	2022-04-07	Moderna	No

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 10 — days 1–6 daily, dose 3

2021-11-06

Systemic reaction (other): lightheadedness and tinnitus

2021-11-07

Systemic reaction (other): Onset of tinnitus and fullness in ears. Both similar to experience after #1 does of Moderna on 1/16. Also, some bladder discomfort (sense of bladder fullness but little to no urination)

Healthcare visit (other): Contacting doctors tomorrow to get appointments

2021-11-08

Systemic reaction (other): Continued tinnitus and full sensation in ears

Healthcare visit (other): Earliest appt available by doctor at end of November

2021-11-09

Systemic reaction (other): Continued tinnitus and fullness in ears

Healthcare visit (other): Testing and doctor visit scheduled for end of month

Release 10 — day 7, dose 3

2021-11-11

Systemic reaction (other): Continued tinnitus and fullness in ears and tenderness on the area around breasts, particularly on the right side. Suspect this symptom is related to vaccine impact on lymph nodes.

Healthcare visit (other): These symptoms are same asExperienced with # 1 and #2 Moderna. ENT appointments scheduled for end of November. Will monitor breast/lymph node tenderness

Release 11 — days 1–6 daily, dose 4

2022-04-10

Systemic reaction (other): Tinnitus and ear fullness

2022-04-11

Systemic reaction (other): Tinnitus and sensation of ear fullness

2022-04-12

Systemic reaction (other): Continued tinnitus and some dizziness

2022-04-13

Systemic reaction (other): Tinnitus

Release 11 — day 7, dose 4

2022-04-16

Systemic reaction (other): Continued tinnitus

Release 12 — 6 months, dose 4

2022-10-07

Symptoms: Got Moderna vax yesterday. Usual sore arm and tires but this time slight dry cough as of today

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	Breast tenderness	·	·	✓
HCVO	Lymph node pain	·	·	✓
HCVO	Unevaluable event	·	·	✓
HCVO	Vaccine positive rechallenge	·	·	✓
SD	Cough	·	·	✓
SD	Fatigue	·	·	✓
SD	Pain in extremity	·	·	✓
SRO	Bladder discomfort	·	·	✓
SRO	Breast tenderness	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Ear congestion	·	·	✓
SRO	Ear discomfort	·	·	✓
SRO	Reaction to previous exposure to any vaccine	·	·	✓
SRO	Tinnitus	·	·	✓
SRO	Urine output decreased	·	·	✓

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