4CY-19247-05536

2 vaccinations 12 coded responses 20 check-ins 11 free-text entries 2 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 915 / CA
Registered: 2021-04-10

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

2021-04-10
Registered in v-safe
2021-04-10
Dose 1 — Janssen/Johnson & Johnson
2021-04-10
Survey response — day 0, dose 1
MedDRA: Dizziness — Feeling: Poor · Fever · Chills · Be unable to do your normal daily activities

Free text: Dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache

Adult check-in
2021-04-14
Survey response — days 1–6 daily, dose 1
MedDRA: Muscle spasms — Feeling: Fair · Site: Pain, Swelling · Headache

Free text: I noticed a cramp in my leg but went away

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — days 1–6 daily, dose 1
MedDRA: Tinnitus — Feeling: Poor · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Tinnitus has set in to my left ear. My left eye is not as open as my right eye.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Survey response — days 1–6 daily, dose 1
MedDRA: Tinnitus — Feeling: Fair · Site: Pain · Headache

Free text: Tinnitus

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Survey response — day 7, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Headache · Be unable to do your normal daily activities

Free text: Dizzy today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Health check-in — day 14, dose 1
Feeling: Poor

Adult check-in
2021-05-01
Survey response — day 21, single dose
MedDRA: Dizziness, Tinnitus — Feeling: Good

Free text: Still have some noise in my left ear sometimes and once in a while I get dizzy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Health check-in — day 28, single dose
Feeling: Good

Adult check-in
2021-05-17
Survey response — day 35, single dose
MedDRA: Rhinorrhoea — Feeling: Fair

Free text: So I throat and my nose is running.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-22
Health check-in — day 42, single dose
Feeling: Good

Adult check-in
2021-07-10
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-10-09
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2022-04-11
Survey response — 12 months, dose 1
MedDRA: Back pain, COVID-19 — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: I got COVID in January. New back pains in the morning. My employer won't higher me because I don't have booster. I don't need booster for at least 5 months after getting COVID. They don't recognize this because of your Suppression of the evidence.

MedDRA releases: 2024-11 · check-in free text available
2022-04-11
Report sent to call center — 12 months, dose 1
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-04-12
Call successful
Participant prefers to complete VAERS report online
2022-05-20
Dose 2 — Moderna
2022-06-26
Survey response — day 35, dose 2
MedDRA: Arthralgia, Pain, Physiotherapy — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Body joint akes · Healthcare visit (other): PT

MedDRA releases: 2024-11 · check-in free text available
2022-06-26
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-06-27
Call 1 — Requested Callback
2022-06-27
Call 1 — Requested Callback
2022-06-27
Callback requested for
03:00PM ET
2022-06-27
Call successful
Participant prefers to complete VAERS report online
2022-08-21
Survey response — 3 months, dose 2
MedDRA: Weight increased — Feeling: Good

Free text: I been gaining weight.

MedDRA releases: 2024-11 · check-in free text available
2022-11-20
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2023-05-20
Survey response — 12 months, dose 2
MedDRA: Pain, Pulmonary pain, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-05-20
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

no matching call case

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-10	Janssen/Johnson & Johnson
2	2022-05-20	Moderna	No

Call center

2 call center cases

2 successful

1 check-in flagged for a call with no call center case on record

See the call center timeline

Free text

Release 7 — day 0, dose 1

2021-04-10

Systemic reaction (other): Dizzy

Release 7 — days 1–6 daily, dose 1

2021-04-11

Systemic reaction (other): Dizzy

2021-04-14

Systemic reaction (other): I noticed a cramp in my leg but went away

2021-04-15

Systemic reaction (other): Tinnitus has set in to my left ear. My left eye is not as open as my right eye.

2021-04-16

Systemic reaction (other): Tinnitus

Release 7 — day 7, dose 1

2021-04-17

Systemic reaction (other): Dizzy today

Release 8 — day 21, single dose

2021-05-01

Symptoms: Still have some noise in my left ear sometimes and once in a while I get dizzy.

Release 8 — day 35, single dose

2021-05-17

Symptoms: So I throat and my nose is running.

Release 11 — 12 months, dose 1

2022-04-11

Symptoms: I got COVID in January. New back pains in the morning. My employer won't higher me because I don't have booster. I don't need booster for at least 5 months after getting COVID. They don't recognize this because of your Suppression of the evidence. cut off by CDC

Release 12 — day 35, dose 2

2022-06-26

Symptoms: Body joint akes

Healthcare visit (other): PT

Release 12 — 3 months, dose 2

2022-08-21

Symptoms: I been gaining weight.

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	Physiotherapy	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Arthralgia	·	·	✓
SD	Back pain	·	·	✓
SD	COVID-19	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Pain	·	·	✓
SD	Pulmonary pain	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Tinnitus	✓	✓	✓
SD	Weight increased	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓
SRO	Tinnitus	✓	✓	✓

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