4FL-66168-43286

3 vaccinations 9 coded responses 16 check-ins 9 free-text entries 5 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 487 / MI
Registered: 2021-03-19

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-03-18
Dose 1 — Janssen/Johnson & Johnson
2021-03-19
Registered in v-safe
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-22
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal discomfort — Feeling: Fair · Diarrhea, Abdominal pain

Free text: I never have GI upset...6 times last eve.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-08
Survey response — day 21, single dose
MedDRA: Pain, Pre-existing disease — Feeling: Fair · 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: R. Leg pain. Entire length, lateral as pect. Was there previously, just worse since shot. In other words, same pain location...just markedly increased. Have 3 bulging L/S discs many yrs.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Report sent to call center — day 21, single dose
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-15
Survey response — day 28, single dose
MedDRA: Myelodysplastic syndrome, Pain in extremity — Feeling: Fair · 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: R. LEG PAIN.2 MDS SUSPECT DISC INVOLVEMENT.AWAITING SCAN APPROVAL FR. INS.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Report sent to call center — day 28, single dose
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-24
Survey response — day 35, single dose
MedDRA: Arthralgia, Unevaluable event — 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, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: R knee& R hip joint pain worsening. Perhaps due To L5/S1 herniation.Pain evident and moderate day of cv19/j&j jab.Much worse 2day. · Healthcare visit (other): R.joint capsule jab w/lidocaine+steroid x 1 inj.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Report sent to call center — day 35, single dose
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)
2021-04-29
Survey response — day 42, single dose
MedDRA: Burning sensation, Myalgia — 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: Sensation of hot-nail being stabbed in great toe, lasts approx. 1-2 sec's. R. Foot only.Muscle on lateral side of lower leg burning sensation intermittent daily, severe@times.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Report sent to call center — day 42, single dose
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-24
Call 1 — Left Voicemail
2021-09-18
Health check-in — 6 months, dose 1
Feeling: Fair

Adult check-in
2021-11-11
Dose 2 — Moderna
2022-03-20
Health check-in — 12 months, dose 1
Feeling: Fair

Adult check-in
2022-05-15
Dose 3 — Moderna
2022-06-30
Survey response — day 42, dose 3
MedDRA: Condition aggravated, Meniere's disease, Tinnitus — Feeling: Fair · Be unable to do your normal daily activities

Free text: The tinnitus from Meniere's disease became louder after my third and last dose of moderna.

MedDRA releases: 2024-11 · check-in free text available
2022-08-14
Survey response — 3 months, dose 3
MedDRA: Pre-existing disease, Tinnitus — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: After the second MODERNA booster, the tinnitus from Meniere's disease, increased significantly. Initial shot J&J. I already had tinnitus, but the second booster really did a number with the ringing. The increased ringing has remained stable&unchanged

MedDRA releases: 2024-11 · check-in free text available
2022-11-13
Survey response — 6 months, dose 3
MedDRA: Dry age-related macular degeneration — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Macular degeneration dry type. Newly diagnosed approximately 1 month ago:bilateral.

MedDRA releases: 2024-11 · check-in free text available
2022-11-13
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-14
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-14
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-14
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-14
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-14
Call successful
2023-05-15
Health check-in — 12 months, dose 3
Feeling: Poor

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-18	Janssen/Johnson & Johnson
2	2021-11-11	Moderna	No
3	2022-05-15	Moderna	No

Call center

5 call center cases

4 successful · 1 unsuccessful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-22

Systemic reaction (other): I never have GI upset...6 times last eve.

2021-03-24

Systemic reaction (other): No

Release 7 — day 21, single dose

2021-04-08

Symptoms: R. Leg pain. Entire length, lateral as pect. Was there previously, just worse since shot. In other words, same pain location...just markedly increased. Have 3 bulging L/S discs many yrs.

Release 7 — day 28, single dose

2021-04-15

Symptoms: R. LEG PAIN.2 MDS SUSPECT DISC INVOLVEMENT.AWAITING SCAN APPROVAL FR. INS.

Release 7 — day 35, single dose

2021-04-24

Symptoms: R knee& R hip joint pain worsening. Perhaps due To L5/S1 herniation.Pain evident and moderate day of cv19/j&j jab.Much worse 2day.

Healthcare visit (other): R.joint capsule jab w/lidocaine+steroid x 1 inj.

Release 8 — day 42, single dose

2021-04-29

Symptoms: Sensation of hot-nail being stabbed in great toe, lasts approx. 1-2 sec's. R. Foot only.Muscle on lateral side of lower leg burning sensation intermittent daily, severe@times.

Release 12 — day 42, dose 3

2022-06-30

Symptoms: The tinnitus from Meniere's disease became louder after my third and last dose of moderna.

Release 12 — 3 months, dose 3

2022-08-14

Symptoms: After the second MODERNA booster, the tinnitus from Meniere's disease, increased significantly. Initial shot J&J. I already had tinnitus, but the second booster really did a number with the ringing. The increased ringing has remained stable&unchanged cut off by CDC

Release 12 — 6 months, dose 3

2022-11-13

Symptoms: Macular degeneration dry type. Newly diagnosed approximately 1 month ago:bilateral.

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	Unevaluable event	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Burning sensation	✓	✓	✓
SD	Condition aggravated	·	·	✓
SD	Dry age-related macular degeneration	·	·	✓
SD	Meniere's disease	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Myelodysplastic syndrome	·	·	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Tinnitus	·	·	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	No adverse event	✓	✓	✓

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