4ZA-12823-97106
2 vaccinations
3 coded responses
25 check-ins
3 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 590 / MT
- Registered
- 2021-02-08
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-08
Registered in v-safe
-
2021-02-08
Dose 1 — Moderna
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-11
- 2021-02-12
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-22
- 2021-03-03
-
2021-03-08
Dose 2 — Moderna
- 2021-03-08
-
2021-03-09
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Headache, Muscle or body achesAdult check-in
- 2021-03-10
- 2021-03-11
- 2021-03-12
- 2021-03-13
- 2021-03-14
- 2021-03-15
- 2021-03-22
- 2021-03-29
-
2021-04-05
Survey response — day 28, dose 2MedDRA: Deafness unilateral, Tinnitus, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: I developed tinnitus shortly after my first vaccine and it worsened after the second vaccine. I have also had about 30% hearing loss in my right ear over the same time. I am not aware of any other potential causes. · Healthcare visit (other): Steroid treatment both orally and through injection in my middle ear. Will have hyperbaric treatments starting this week.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-05
Report sent to call center — day 28, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2021-04-12
Survey response — day 35, dose 2MedDRA: Deafness, Deafness unilateral, Middle ear disorder, Tinnitus, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: I am being treated for Tinnitus. Not 100% sure that it is related to the vaccine, but think so. The onset of this condition started shortly after my first shot. It is now a consistent ringing and I have suffered 30% hearing loss in my right ear. · Healthcare visit (other): Hyperbaric treatments, steroid shots into my middle ear.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-12
Report sent to call center — day 35, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-19
- 2021-06-10
- 2021-06-17
-
2022-03-10
Survey response — 12 months, dose 2MedDRA: Office visit, Rash, Rash pruritic, Urticaria — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Hives or itchy rash on my back, which started with my booster. · Healthcare visit (other): Visit with my internist.MedDRA releases: 2024-11 · check-in free text available
-
2022-03-10
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2022-03-14
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-08 | Moderna | |
| 2 | 2021-03-08 | Moderna |
Call center
3 call center cases
3 unsuccessful
Free text
Release 6 — day 28, dose 2
Symptoms: I developed tinnitus shortly after my first vaccine and it worsened after the second vaccine. I have also had about 30% hearing loss in my right ear over the same time. I am not aware of any other potential causes.
Healthcare visit (other): Steroid treatment both orally and through injection in my middle ear. Will have hyperbaric treatments starting this week.
Release 7 — day 35, dose 2
Symptoms: I am being treated for Tinnitus. Not 100% sure that it is related to the vaccine, but think so. The onset of this condition started shortly after my first shot. It is now a consistent ringing and I have suffered 30% hearing loss in my right ear. cut off by CDC
Healthcare visit (other): Hyperbaric treatments, steroid shots into my middle ear.
Release 11 — 12 months, dose 2
Symptoms: Hives or itchy rash on my back, which started with my booster.
Healthcare visit (other): Visit with my internist.
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 | Middle ear disorder | ○ | ✓ | ○ |
| HCVO | Office visit | · | · | ✓ |
| HCVO | Unevaluable event | ✓ | ✓ | ✓ |
| SD | Deafness | ○ | ✓ | ○ |
| SD | Deafness unilateral | ✓ | ✓ | ✓ |
| SD | Rash | · | · | ✓ |
| SD | Rash pruritic | · | · | ✓ |
| SD | Tinnitus | ✓ | ✓ | ✓ |
| SD | Urticaria | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release