ZLQ-31648-23859

5 vaccinations 12 coded responses 30 check-ins 11 free-text entries 1 call case

Sex: Male
Age at first dose: 56-60
ZIP prefix: 481 / MI
Registered: 2021-04-22

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

2021-03-25
Dose 1 — Moderna
2021-04-22
Registered in v-safe
2021-04-22
Dose 2 — Moderna
2021-04-22
Survey response — day 0, dose 2
MedDRA: Actinic keratosis, Arthritis, Chemotherapy, Fibromyalgia, Hypersensitivity, Plasma cell myeloma, Pre-existing disease — Feeling: Good · Joint pains, Muscle or body aches · Be unable to work, 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: Systemic reaction (other): Multiple Myeloma, Fibromyalgia, Actinic Kerotosis, Arthritis, Allergies · Healthcare visit (other): Chemotherapy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Report sent to call center — day 0, dose 2
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Actinic keratosis, Arthritis, Chemotherapy, Hypersensitivity, Hypertension, Plasma cell myeloma, Pre-existing disease — Feeling: Poor · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to work, Be unable to do your normal daily activities

Free text: Multiple myeloma, and the chemotherapy is likely the cause of these symptoms. Actinic Kerotosis, Arthritis, Allergies, Hypertension, Hypercholesterolosis.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · None

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-28
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease — Feeling: Good · Joint pains, Muscle or body aches, Diarrhea · Be unable to work

Free text: Chronic pain in the form of Fibromyalgia, arthritis, multiple myeloma, Actinic Kerotosis, allergies, multiple medications cause constipation and I am taking both polyethylene glycol 3350 and ducosate sodium and I have probably overdone the meds but adjustments take a few days to have effect.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Survey response — day 7, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Joint pains, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Fibr and Multiple Myeloma

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-13
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-20
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-27
Survey response — day 35, dose 2
MedDRA: Poor quality sleep, Pre-existing disease — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Poor sleep and related issues, due to extended chemotherapy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-03
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-21
Survey response — 6 months, dose 2
MedDRA: Constipation, Diarrhoea, Pain, Pre-existing disease, Self-medication — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Chronic pain has gotten worse. However other side effects from chemotherapy are subsiding: I finally got the diarrhea but that quickly turned to constipation and now I am back to needing laxative and stool softener at level about where I was before.

MedDRA releases: 2024-11 · check-in free text available
2021-11-10
Dose 3 — Moderna
2022-04-04
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-10
Dose 4 — Moderna
2022-04-23
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-04-23
Health check-in — day 7, dose 4
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-04-24
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-01
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-05-08
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-15
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-22
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-10
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-15
Dose 5 — Moderna
2022-10-09
Survey response — day 21, dose 5
MedDRA: Office visit, Tooth infection — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Tooth infection. Dentist wanted it pulled. Oral surgeon said need root canal. Zometa infusions for last 19 months mean I am likely to have complications. Especially since it is lower jaw. 9-12-22 is root canal date. May get 2 root canals.

MedDRA releases: 2024-11 · check-in free text available
2022-10-09
Survey response — 6 months, dose 4
MedDRA: Dental care, Oral hyperaesthesia, Pre-existing disease, Tooth infection, Toothache — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I got a tooth infection. I had pain from anything cold. The dentist found a leak under a crown from 2004. He sealed it with bond. 30 hours later I was in a lot of pain and it was getting worse. The dentist prescribed an antibiotic. More info, no room

MedDRA releases: 2024-11 · check-in free text available
2022-10-13
Survey response — day 28, dose 5
MedDRA: Endodontic procedure, Pre-existing disease, Tooth infection — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I had a tooth infection. Extraction was bad idea due to Zometa infusions. I had 1 root canal and will be getting a 2nd next week. I was on amoxicillin for 7 days. I restarted acyclovir when it began. 800 mg 2/day, went down to 400 mg 2/day at 8 days.

MedDRA releases: 2024-11 · check-in free text available
2022-10-20
Survey response — day 35, dose 5
MedDRA: Arthritis, Hypersensitivity, Pre-existing disease, SARS-CoV-2 test negative, Sensitivity to weather change, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities

Free text: Arthritis is worse due to cold wet weather. Allergies are still bad. I stopped using Flonase because I started getting bloody nose. I did perform an at home COVID test as I have a sibling who thought my symptoms could be a mild case. Negative result.

MedDRA releases: 2024-11 · check-in free text available
2022-10-27
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-15
Survey response — 3 months, dose 5
MedDRA: Malaise, Oropharyngeal pain, Respiratory syncytial virus infection, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Sick. Likely mild case of RSV. I did not go to a doctor, information said there is no treatment. I never ran a fever. Started Nov 13 with very sore throat. Had very runny nose for a week. No symptoms since Dec 4. COVID test negative Nov 14, 18 & 22.

MedDRA releases: 2024-11 · check-in free text available
2023-03-16
Survey response — 6 months, dose 5
MedDRA: Arthritis, Fatigue, Pain — Feeling: Poor · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-25	Moderna
2	2021-04-22	Moderna
3	2021-11-10	Moderna	No
4	2022-04-10	Moderna	No
5	2022-09-15	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-22	Successful 2022-04-04	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 7 — day 0, dose 2

2021-04-22

Systemic reaction (other): Multiple Myeloma, Fibromyalgia, Actinic Kerotosis, Arthritis, Allergies

Healthcare visit (other): Chemotherapy

Release 7 — days 1–6 daily, dose 2

2021-04-23

Systemic reaction (other): Multiple myeloma, and the chemotherapy is likely the cause of these symptoms. Actinic Kerotosis, Arthritis, Allergies, Hypertension, Hypercholesterolosis.

Release 8 — days 1–6 daily, dose 2

2021-04-28

Systemic reaction (other): Chronic pain in the form of Fibromyalgia, arthritis, multiple myeloma, Actinic Kerotosis, allergies, multiple medications cause constipation and I am taking both polyethylene glycol 3350 and ducosate sodium and I have probably overdone the meds but adjustments take a few days to have effect.

Release 8 — day 7, dose 2

2021-04-29

Systemic reaction (other): Fibr and Multiple Myeloma

Release 8 — day 35, dose 2

2021-05-27

Symptoms: Poor sleep and related issues, due to extended chemotherapy.

Release 10 — 6 months, dose 2

2021-10-21

Symptoms: Chronic pain has gotten worse. However other side effects from chemotherapy are subsiding: I finally got the diarrhea but that quickly turned to constipation and now I am back to needing laxative and stool softener at level about where I was before. cut off by CDC

Release 12 — 6 months, dose 4

2022-10-09

Symptoms: I got a tooth infection. I had pain from anything cold. The dentist found a leak under a crown from 2004. He sealed it with bond. 30 hours later I was in a lot of pain and it was getting worse. The dentist prescribed an antibiotic. More info, no room cut off by CDC

Release 12 — day 21, dose 5

2022-10-09

Symptoms: Tooth infection. Dentist wanted it pulled. Oral surgeon said need root canal. Zometa infusions for last 19 months mean I am likely to have complications. Especially since it is lower jaw. 9-12-22 is root canal date. May get 2 root canals.

Release 12 — day 28, dose 5

2022-10-13

Symptoms: I had a tooth infection. Extraction was bad idea due to Zometa infusions. I had 1 root canal and will be getting a 2nd next week. I was on amoxicillin for 7 days. I restarted acyclovir when it began. 800 mg 2/day, went down to 400 mg 2/day at 8 days. cut off by CDC

Release 12 — day 35, dose 5

2022-10-20

Symptoms: Arthritis is worse due to cold wet weather. Allergies are still bad. I stopped using Flonase because I started getting bloody nose. I did perform an at home COVID test as I have a sibling who thought my symptoms could be a mild case. Negative result. cut off by CDC

Release 12 — 3 months, dose 5

2022-12-15

Symptoms: Sick. Likely mild case of RSV. I did not go to a doctor, information said there is no treatment. I never ran a fever. Started Nov 13 with very sore throat. Had very runny nose for a week. No symptoms since Dec 4. COVID test negative Nov 14, 18 & 22. cut off by CDC

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	Chemotherapy	✓	✓	✓
SD	Arthritis	·	·	✓
SD	Constipation	·	·	✓
SD	Dental care	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Endodontic procedure	·	·	✓
SD	Fatigue	·	·	✓
SD	Hypersensitivity	·	·	✓
SD	Malaise	·	·	✓
SD	Office visit	·	·	✓
SD	Oral hyperaesthesia	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Poor quality sleep	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Respiratory syncytial virus infection	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Self-medication	·	·	✓
SD	Sensitivity to weather change	·	·	✓
SD	Tooth infection	·	·	✓
SD	Toothache	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Actinic keratosis	✓	✓	✓
SRO	Arthritis	✓	✓	✓
SRO	Chemotherapy	✓	✓	✓
SRO	Fibromyalgia	✓	✓	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Hypertension	✓	✓	✓
SRO	Plasma cell myeloma	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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