Z94-21931-42426

2 vaccinations 15 coded responses 27 check-ins 15 free-text entries 11 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 220 / VA
Registered: 2021-01-23

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

Timeline

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

2021-01-23
Registered in v-safe
2021-01-23
Dose 1 — Moderna
2021-01-23
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-30
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-20
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-27
Dose 2 — Moderna
2021-02-27
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Deafness — Feeling: Fair · Site: Pain · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Some hearing loss

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Deafness — Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: I lost hearing in right ear completely

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Deafness unilateral, Office visit — Feeling: Poor · Be unable to work, 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: Systemic reaction (other): Complete hearing loss on my right ear · Healthcare visit (other): Visited otolaryngologist and got treatment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Report sent to call center — days 1–6 daily, dose 2
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)
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Deafness unilateral — Feeling: Poor · Fatigue or tiredness, Nausea, Diarrhea · Be unable to work, 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: I completely lost hearing in my right ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Report sent to call center — days 1–6 daily, dose 2
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)
2021-03-04
Survey response — days 1–6 daily, dose 2
MedDRA: Deafness unilateral, Medical counselling — Feeling: Poor · Nausea · Be unable to work, 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: Systemic reaction (other): Complete hearing loss in right ear · Healthcare visit (other): Got treatment with an ear dr, taking medications

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Report sent to call center — days 1–6 daily, dose 2
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)
2021-03-05
Survey response — days 1–6 daily, dose 2
MedDRA: Deafness, Deafness unilateral — Feeling: Poor · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Complete hearing loss in my right ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Survey response — day 7, dose 2
MedDRA: Deafness, Deafness unilateral — Feeling: Poor · Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: Complete hearing loss in right ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Survey response — day 14, dose 2
MedDRA: Deafness — Feeling: Poor · Be unable to work, 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: Complete hearing loss in my right ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Report sent to call center — day 14, dose 2
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)
2021-03-20
Survey response — day 21, dose 2
MedDRA: Deafness bilateral — Feeling: Poor · Be unable to work, 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: Complete hearing loss in right ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 21, dose 2
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)
2021-03-27
Survey response — day 28, dose 2
MedDRA: Deafness unilateral — Feeling: Poor · Be unable to work, 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: Total hearing loss in right ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Report sent to call center — day 28, dose 2
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)
2021-04-03
Survey response — day 35, dose 2
MedDRA: Deafness unilateral — Feeling: Poor · Be unable to work, 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: Complete hearing loss in my right ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Report sent to call center — day 35, dose 2
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)
2021-04-10
Survey response — day 42, dose 2
MedDRA: Deafness — Feeling: Poor · Be unable to work, 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: Complete hearing loss in my right ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Report sent to call center — day 42, dose 2
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)
2021-05-29
Survey response — 3 months, dose 2
MedDRA: Deafness unilateral — Feeling: Poor · Be unable to work, 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: Complete hearing loss in my right ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-29
Report sent to call center — 3 months, dose 2
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)
2021-06-15
Call 1 — Left Voicemail
2021-08-28
Survey response — 6 months, dose 2
MedDRA: Deafness unilateral, Tinnitus — Feeling: Poor · 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: Complete loss of hearing in my right ear, strong tinnitus

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-28
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-31
Call 1 — Could Not Reach Participant
2021-09-02
Call 2 — Could Not Reach Participant
2022-03-01
Survey response — 12 months, dose 2
MedDRA: Deafness, Deafness unilateral — Feeling: Poor · 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: Complete loss of hearing in right ear

MedDRA releases: 2024-11 · check-in free text available
2022-03-01
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-03
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-23	Moderna
2	2021-02-27	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-02	Unsuccessful
2021-03-03	Unsuccessful
2021-03-04	Unsuccessful
2021-03-13	Unsuccessful
2021-03-20	Unsuccessful
2021-03-27	Unsuccessful
2021-04-03	Unsuccessful
2021-04-10	Unsuccessful
2021-05-29	Unsuccessful
2021-08-28	Unsuccessful
2022-03-01	Unsuccessful

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-28

Systemic reaction (other): Some hearing loss

2021-03-01

Systemic reaction (other): I lost hearing in right ear completely

2021-03-02

Systemic reaction (other): Complete hearing loss on my right ear

Healthcare visit (other): Visited otolaryngologist and got treatment

Release 5 — days 1–6 daily, dose 2

2021-03-03

Systemic reaction (other): I completely lost hearing in my right ear

2021-03-04

Systemic reaction (other): Complete hearing loss in right ear

Healthcare visit (other): Got treatment with an ear dr, taking medications

2021-03-05

Systemic reaction (other): Complete hearing loss in my right ear

Release 5 — day 7, dose 2

2021-03-06

Systemic reaction (other): Complete hearing loss in right ear

Release 5 — day 14, dose 2

2021-03-13

Symptoms: Complete hearing loss in my right ear

Release 6 — day 21, dose 2

2021-03-20

Symptoms: Complete hearing loss in right ear

Release 6 — day 28, dose 2

2021-03-27

Symptoms: Total hearing loss in right ear

Release 6 — day 35, dose 2

2021-04-03

Symptoms: Complete hearing loss in my right ear

Release 7 — day 42, dose 2

2021-04-10

Symptoms: Complete hearing loss in my right ear

Release 8 — 3 months, dose 2

2021-05-29

Symptoms: Complete hearing loss in my right ear

Release 9 — 6 months, dose 2

2021-08-28

Symptoms: Complete loss of hearing in my right ear, strong tinnitus

Release 11 — 12 months, dose 2

2022-03-01

Symptoms: Complete loss of hearing in right ear

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	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Deafness	✓	✓	✓
SD	Deafness bilateral	✓	✓	✓
SD	Deafness unilateral	✓	✓	✓
SD	Tinnitus	✓	·	✓
SRO	Deafness	✓	✓	✓
SRO	Deafness unilateral	✓	✓	✓

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