ZT5-31696-96194

3 vaccinations 5 coded responses 26 check-ins 5 free-text entries 3 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 980 / WA
Registered: 2021-01-18

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-01-18
Registered in v-safe
2021-01-18
Dose 1 — Moderna
2021-01-18
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, 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
2021-01-28
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-10
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-15
Dose 2 — Moderna
2021-02-15
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-18
Survey response — days 1–6 daily, dose 2
MedDRA: Tinnitus — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Ringing ears

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-22
Health check-in — day 7, dose 2
Feeling: Good · None

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

Adult check-in
2021-03-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-17
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-22
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-30
Survey response — day 42, dose 2
MedDRA: Back pain, Cyst, Pain, Sciatica, Unevaluable event — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: Lower back pain. Extreme sciatica caused by a cyst L4 L5. Cyst removed by laminectomy yesterday. Sciatica gone. Cyst appeared to be there for a long time. Dr did not link it to Covid. Pain started in late December 2020. Did not think to report ea · Healthcare visit (other): 2 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
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)
2021-05-17
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-16
Survey response — 6 months, dose 2
MedDRA: Cardiac disorder, Chest pain, Emergency care, Fatigue, SARS-CoV-2 test negative, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Symptoms: Possible heart issues . Chest pains fatigue last week. Went to er no issue found. Took Covid test it was negative. Continuing to monitor my heart. Feel better today. · Healthcare visit (other): See above

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-16
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-23
Call 1 — Left Voicemail
2021-09-02
Dose 3 — Moderna
2021-12-02
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-09-02
Survey response — 12 months, dose 3
MedDRA: Office visit, Parkinson's disease, Physiotherapy — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: I was diagnosed with Parkinson's disease in January 2022 · Healthcare visit (other): Neurologist visit and physical therapist

MedDRA releases: 2024-11 · check-in free text available
2022-09-02
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-09-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-09-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-09-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-18	Moderna
2	2021-02-15	Moderna
3	2021-09-02	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-30	Successful 2022-09-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-08-16	Successful 2022-09-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-09-02	Successful 2022-09-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-19

Systemic reaction (other): No

Release 4 — days 1–6 daily, dose 2

2021-02-18

Systemic reaction (other): Ringing ears

Release 6 — day 42, dose 2

2021-03-30

Symptoms: Lower back pain. Extreme sciatica caused by a cyst L4 L5. Cyst removed by laminectomy yesterday. Sciatica gone. Cyst appeared to be there for a long time. Dr did not link it to Covid. Pain started in late December 2020. Did not think to report ea cut off by CDC

Healthcare visit (other): 2 days

Release 9 — 6 months, dose 2

2021-08-16

Symptoms: Possible heart issues . Chest pains fatigue last week. Went to er no issue found. Took Covid test it was negative. Continuing to monitor my heart. Feel better today.

Healthcare visit (other): See above

Release 12 — 12 months, dose 3

2022-09-02

Symptoms: I was diagnosed with Parkinson's disease in January 2022

Healthcare visit (other): Neurologist visit and physical therapist

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	·	·	✓
HCVO	Physiotherapy	·	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Cardiac disorder	✓	·	✓
SD	Chest pain	✓	·	✓
SD	Cyst	✓	✓	✓
SD	Emergency care	✓	·	✓
SD	Fatigue	✓	·	✓
SD	Pain	✓	✓	✓
SD	Parkinson's disease	·	·	✓
SD	SARS-CoV-2 test negative	✓	·	✓
SD	Sciatica	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Tinnitus	✓	✓	✓

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