ZRH-21138-93508

5 vaccinations 25 coded responses 52 check-ins 23 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 437 / OH
Registered: 2021-01-26

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

2021-01-25
Dose 1 — Moderna
2021-01-26
Registered in v-safe
2021-01-26
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain, Neuropathy peripheral, Pain in extremity, Pre-existing disease — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Pain in feet and legs; have neuropathy and when arm pain at injection site, strong pain at neuropathy area.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain, Pain in extremity, Paraesthesia — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Continuing tingling and pain in feet and lower legs only when I feel pain in and around injection sight and area

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site discomfort — Feeling: Good · Site: Pain

Free text: Very slight discomfort at injection area with no

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-30
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Good · Fatigue or tiredness

Free text: Seem to be mortised in these 4th and 5th days after the vacination, its not bad but a lot more tired than previous days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Good · Fatigue or tiredness

Free text: Tiredness not bothering today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Survey response — day 7, dose 1
MedDRA: Oral mucosal eruption — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: A little rash on the roof of my mouth, something different that I havent ever noticed before. Doesnt bother, just a little annoying.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-15
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-22
Dose 2 — Moderna
2021-02-22
Survey response — day 0, dose 2
MedDRA: Pain, Pre-existing disease, Tenderness, Vaccine positive rechallenge — Feeling: Good · Site: Pain

Free text: As with my first shot, I have mild pain in my lower leg and feet increased after shot; also had dental work last Friday and area in mouth at location of the numbing shot which was a little tender became increasingly tender and increase to pain at that area only after the shot. Mild pain, but noticeable increased sensations, mild.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-24
Survey response — days 1–6 daily, dose 2
MedDRA: Self-medication — Feeling: Good · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Symptoms got better with a mix of Tylenol and ibuprofen all during day and night

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: Pain — Feeling: Good · Site: Pain, Swelling · Fever · Muscle or body aches

Free text: Aches are minor and going away

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: Pain, Pain in extremity, Self-medication — Feeling: Good · Site: Pain, Swelling, Itching · Joint pains, Muscle or body aches

Free text: Stopped taking alternate Tylenol and ibuprofen yesterday afternoon; then body aches and leg foot pain started again; started taking meds again this morning and the aches and pains are slowing.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Survey response — days 1–6 daily, dose 2
MedDRA: Self-medication — Feeling: Good · Site: Pain, Swelling, Itching · Muscle or body aches

Free text: Diminishing with starting back with my Tylenol and ibuprofen alternating mix

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Good · Site: Swelling, Itching · Muscle or body aches

Free text: Very minor back ache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Health check-in — day 7, dose 2
Feeling: Good · Site: Swelling · None

Adult check-in
2021-03-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-15
Survey response — day 21, dose 2
MedDRA: Blood glucose increased, Pre-existing disease — Feeling: Good

Free text: Have type 2 diabetes, glucose readings have increased about 25%; probable doesnt have to do with vacination , but Im noting it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-05
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-24
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-23
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-26
Dose 3 — Moderna
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: Pre-existing disease — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Have neuropathy in both legs and feet, a lot af pain in both, especially when my arm hurts

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Abdominal pain upper, Injection site reaction, Neuralgia, Neuropathy peripheral, Pain — Feeling: Fair · Site: Pain, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Free text: My neuropathy is still painful transferring from the site of my shot to my legs and feet and radiates upwards to my stomach area.

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Neuropathy pain is waxing up

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Neuralgia — Feeling: Fair · Site: Pain, Itching · Headache, Fatigue or tiredness

Free text: Added neuropathy pain in legs and feet,still present-mild

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Eye disorder, Photopsia — Feeling: Fair · Site: Pain, Itching · Muscle or body aches, Fatigue or tiredness

Free text: Have noticed peripheral light flashes in eyes along with the eye cobwebs

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Survey response — days 1–6 daily, dose 3
MedDRA: Neuralgia, Vitreous floaters — Feeling: Good · Site: Itching · Fatigue or tiredness

Free text: Eye floaters have increased greatly; neuropathy pain in feet and legs decreasing.

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Survey response — day 7, dose 3
MedDRA: Neuropathy peripheral, Pain in extremity, Photopsia, Vitreous floaters — Feeling: Good · Site: Itching · Fatigue or tiredness

Free text: Eye floaters with peripheral flashes - neuropathy leg and foot pain mild only at nighttime

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-16
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-07
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-26
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-05-03
Dose 4 — Moderna
2022-05-19
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-31
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-07
Survey response — day 35, dose 4
MedDRA: Visual impairment, Vitreous floaters — Feeling: Good

Free text: My eyesight has decreased, a good amount of floaters and distance vision has decreased. Noticed difference since last booster.

MedDRA releases: 2024-11 · check-in free text available
2022-06-14
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-02
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-04
Dose 5 — Pfizer-BioNTech
2022-10-17
Survey response — day 7, dose 5
MedDRA: Pain in extremity, Pre-existing disease — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Pain at site of my neuropathy in my feet and legs

MedDRA releases: 2024-11 · check-in free text available
2022-10-18
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-25
Survey response — day 21, dose 5
MedDRA: Abdominal discomfort, Diarrhoea — Feeling: Good

Free text: A one day bout with gastric upset, diarrhea, lasted only a day; unknown why. Over it.

MedDRA releases: 2024-11 · check-in free text available
2022-11-01
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-08
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-15
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-04
Survey response — 3 months, dose 5
MedDRA: Asthma, Emergency care, Influenza A virus test positive, Influenza virus test negative, Office visit, Oxygen saturation decreased, Respiratory tract congestion — 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, Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-01-04
Report sent to call center — 3 months, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2023-01-05
Call 1 — Left Voicemail
2023-04-04
Survey response — 6 months, dose 5
MedDRA: Asthma, Bronchitis — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-04-04
Report sent to call center — 6 months, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2023-04-05
Call 2 — Left Voicemail
2023-04-05
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-25	Moderna
2	2021-02-22	Moderna
3	2021-10-26	Moderna	No
4	2022-05-03	Moderna	No
5	2022-10-04	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2023-01-04	Unsuccessful
2023-04-04	Unsuccessful

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-26

Systemic reaction (other): Pain in feet and legs; have neuropathy and when arm pain at injection site, strong pain at neuropathy area.

2021-01-27

Systemic reaction (other): Continuing tingling and pain in feet and lower legs only when I feel pain in and around injection sight and area

Release 3 — days 1–6 daily, dose 1

2021-01-28

Systemic reaction (other): Very slight discomfort at injection area with no

2021-01-30

Systemic reaction (other): Seem to be mortised in these 4th and 5th days after the vacination, its not bad but a lot more tired than previous days.

2021-01-31

Systemic reaction (other): Tiredness not bothering today

Release 3 — day 7, dose 1

2021-02-01

Systemic reaction (other): A little rash on the roof of my mouth, something different that I havent ever noticed before. Doesnt bother, just a little annoying.

Release 4 — day 0, dose 2

2021-02-22

Systemic reaction (other): As with my first shot, I have mild pain in my lower leg and feet increased after shot; also had dental work last Friday and area in mouth at location of the numbing shot which was a little tender became increasingly tender and increase to pain at that area only after the shot. Mild pain, but noticeable increased sensations, mild.

Release 4 — days 1–6 daily, dose 2

2021-02-24

Systemic reaction (other): Symptoms got better with a mix of Tylenol and ibuprofen all during day and night

2021-02-25

Systemic reaction (other): Aches are minor and going away

2021-02-26

Systemic reaction (other): Stopped taking alternate Tylenol and ibuprofen yesterday afternoon; then body aches and leg foot pain started again; started taking meds again this morning and the aches and pains are slowing.

2021-02-27

Systemic reaction (other): Diminishing with starting back with my Tylenol and ibuprofen alternating mix

2021-02-28

Systemic reaction (other): Very minor back ache

Release 5 — day 21, dose 2

2021-03-15

Symptoms: Have type 2 diabetes, glucose readings have increased about 25%; probable doesnt have to do with vacination , but Im noting it.

Release 10 — days 1–6 daily, dose 3

2021-10-27

Systemic reaction (other): Have neuropathy in both legs and feet, a lot af pain in both, especially when my arm hurts

2021-10-28

Systemic reaction (other): My neuropathy is still painful transferring from the site of my shot to my legs and feet and radiates upwards to my stomach area.

2021-10-29

Systemic reaction (other): Neuropathy pain is waxing up

2021-10-30

Systemic reaction (other): Added neuropathy pain in legs and feet,still present-mild

2021-10-31

Systemic reaction (other): Have noticed peripheral light flashes in eyes along with the eye cobwebs

2021-11-01

Systemic reaction (other): Eye floaters have increased greatly; neuropathy pain in feet and legs decreasing.

Release 10 — day 7, dose 3

2021-11-02

Systemic reaction (other): Eye floaters with peripheral flashes - neuropathy leg and foot pain mild only at nighttime

Release 11 — day 35, dose 4

2022-06-07

Symptoms: My eyesight has decreased, a good amount of floaters and distance vision has decreased. Noticed difference since last booster.

Release 12 — day 7, dose 5

2022-10-17

Systemic reaction (other): Pain at site of my neuropathy in my feet and legs

Release 12 — day 21, dose 5

2022-10-25

Symptoms: A one day bout with gastric upset, diarrhea, lasted only a day; unknown why. Over it.

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
SD	Abdominal discomfort	·	·	✓
SD	Asthma	·	·	✓
SD	Blood glucose increased	✓	✓	✓
SD	Bronchitis	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Emergency care	·	·	✓
SD	Influenza A virus test positive	·	·	✓
SD	Influenza virus test negative	·	·	✓
SD	Office visit	·	·	✓
SD	Oxygen saturation decreased	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Respiratory tract congestion	·	·	✓
SD	Visual impairment	·	·	✓
SD	Vitreous floaters	·	·	✓
SRO	Abdominal pain upper	·	·	✓
SRO	Back pain	✓	✓	✓
SRO	Condition aggravated	·	·	✓
SRO	Eye disorder	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Injection site discomfort	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Injection site reaction	·	·	✓
SRO	Neuralgia	·	·	✓
SRO	Neuropathy peripheral	✓	✓	✓
SRO	Oral mucosal eruption	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Photopsia	·	·	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Tenderness	✓	✓	✓
SRO	Vaccine positive rechallenge	✓	✓	✓
SRO	Vitreous floaters	·	·	✓

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