ZGM-15828-22139

4 vaccinations 8 coded responses 33 check-ins 8 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 276 / NC
Registered: 2021-02-15

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

2021-02-15
Registered in v-safe
2021-02-15
Dose 1 — Moderna
2021-02-15
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-22
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-14
Dose 2 — Moderna
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Poor · Site: Pain · Chills, Muscle or body aches

Free text: None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-17
Survey response — days 1–6 daily, dose 2
MedDRA: Muscle spasms — Feeling: Good

Free text: Noticed am getting cramps on my left thumb while driving and left toes yesterday; same day. New to me but nit experiencing today. Any input? Thanks

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-20
Survey response — days 1–6 daily, dose 2
MedDRA: Disorientation, Thinking abnormal — Feeling: Fair

Free text: Sudden lost sense of direction; only quick then okay

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Survey response — day 7, dose 2
MedDRA: Unevaluable event — Feeling: Good

Free text: Wearing kn95 mask seems am gasping for air

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-04
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-18
Survey response — day 35, dose 2
MedDRA: Sinus disorder — Feeling: Fair

Free text: Sinus issue; is it pollen?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-13
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-12
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-15
Dose 3 — Moderna
2022-03-16
Survey response — 12 months, dose 2
MedDRA: Chest discomfort, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Feeling weird on chest; cardiologist thought it is missed hearbeat. · Healthcare visit (other): Cardiologist

MedDRA releases: 2024-11 · check-in free text available
2022-03-16
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2022-03-17
Call 1 — Left Voicemail
2022-03-18
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-05-05
Dose 4 — Pfizer-BioNTech
2022-05-17
Survey response — day 7, dose 4
MedDRA: Dizziness — Feeling: Good

Free text: Lately lightheadedness that is tolerable. I did not have this before.

MedDRA releases: 2024-11 · check-in free text available
2022-05-19
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-26
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-03
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-09
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-16
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-04
Survey response — 3 months, dose 4
MedDRA: Disorientation, Influenza — Feeling: Good

Free text: flu symptoms and one time disorientation in June 22.

MedDRA releases: 2024-11 · check-in free text available
2022-11-03
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-05
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-15	Moderna
2	2021-03-14	Moderna
3	2021-11-15	Moderna	No
4	2022-05-05	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-03-16	Successful 2022-03-18	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-15

Systemic reaction (other): None

2021-03-17

Systemic reaction (other): Noticed am getting cramps on my left thumb while driving and left toes yesterday; same day. New to me but nit experiencing today. Any input? Thanks

Release 6 — days 1–6 daily, dose 2

2021-03-20

Systemic reaction (other): Sudden lost sense of direction; only quick then okay

Release 6 — day 7, dose 2

2021-03-21

Systemic reaction (other): Wearing kn95 mask seems am gasping for air

Release 7 — day 35, dose 2

2021-04-18

Symptoms: Sinus issue; is it pollen?

Release 11 — 12 months, dose 2

2022-03-16

Symptoms: Feeling weird on chest; cardiologist thought it is missed hearbeat.

Healthcare visit (other): Cardiologist

Release 11 — day 7, dose 4

2022-05-17

Systemic reaction (other): Lately lightheadedness that is tolerable. I did not have this before.

Release 12 — 3 months, dose 4

2022-08-04

Symptoms: flu symptoms and one time disorientation in June 22.

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	Office visit	·	·	✓
SD	Chest discomfort	·	·	✓
SD	Disorientation	·	·	✓
SD	Influenza	·	·	✓
SD	Office visit	·	·	✓
SD	Sinus disorder	✓	✓	✓
SRO	Disorientation	✓	·	✓
SRO	Dizziness	·	·	✓
SRO	Muscle spasms	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Thinking abnormal	○	✓	○
SRO	Unevaluable event	✓	✓	✓

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