ZT7-28079-65320

1 vaccination 11 coded responses 11 check-ins 11 free-text entries 1 call case

Sex: Male
Age at first dose: 51-55
ZIP prefix: 925 / CA
Registered: 2021-06-10

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

2021-06-10
Registered in v-safe
2021-06-10
Dose 1 — Moderna
2021-06-10
Survey response — day 0, dose 1
MedDRA: Gastrointestinal sounds abnormal, Hypoaesthesia, Migraine, Musculoskeletal stiffness, Neck pain, Pain, Paraesthesia, Testicular pain — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Stomach gurgling, testicular pain on side of injection, neck pain stiff neck, migraine, intermittent shooting pains from left side, numbness tingling sensations hand and foot.(b)(6)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-11
Survey response — days 1–6 daily, dose 1
MedDRA: Flushing, Hyperhidrosis, Musculoskeletal stiffness, Neck pain, Night sweats, Tinnitus — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Flush, sweating, night sweats (soaked shirt), continous ear ringing, neck stiffness, neck aches,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-12
Survey response — days 1–6 daily, dose 1
MedDRA: Flushing, Hyperhidrosis — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Flush, sweats,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-13
Survey response — days 1–6 daily, dose 1
MedDRA: Flushing, Hyperhidrosis — Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness

Free text: Flushing, sweats

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-14
Survey response — days 1–6 daily, dose 1
MedDRA: Flushing, Hyperhidrosis, Night sweats, Tinnitus — Feeling: Fair · Site: Pain · Headache

Free text: Continued ringing in both ears. Feel flush, Day and nightsweats

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-15
Survey response — days 1–6 daily, dose 1
MedDRA: Haemorrhage, Oropharyngeal pain, Pain in extremity, Paraesthesia, Tinnitus — Feeling: Fair · Site: Pain · Headache, Diarrhea, Abdominal pain

Free text: Ringing in ears, Sore Throat (New), Bleed easily, pins and needles in left lower extremities (bottom of foot) and hand Left side w/aches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-16
Survey response — days 1–6 daily, dose 1
MedDRA: Cold sweat, Eye irritation, Feeling of body temperature change, Hyperhidrosis, Ocular hyperaemia, Paraesthesia, Tinnitus, Tremor — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea

Free text: Ear ringing, tingling left hand & ball of left foot, hand tremors, red burning eyes (2 days), cold/hot sweats

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-19
Survey response — day 7, dose 1
MedDRA: Tinnitus — Feeling: Fair · Headache, Joint pains, Fatigue or tiredness

Free text: Ear ringing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-24
Survey response — day 14, dose 1
MedDRA: Arthralgia, Lymphadenopathy, Tinnitus — Feeling: Fair

Free text: Swollen lymph nodes, (left) ear ringing (continued), joint pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-01
Survey response — day 21, dose 1
MedDRA: Lymphadenopathy, Night sweats, Tinnitus — Feeling: Fair

Free text: Gland swelling (same side of injection) continued night sweats, continued ringing in ears.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2022-06-12
Survey response — 12 months, dose 1
MedDRA: Thrombosis, Tinnitus — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, 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: Continued ringing in ear. Suspected bllod clot left leg.

MedDRA releases: 2024-11 · check-in free text available
2022-06-12
Report sent to call center — 12 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-13
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-06-10	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2022-06-12	Successful 2022-06-13	Does not wish to fill out VAERS report

Free text

Release 9 — day 0, dose 1

2021-06-10

Systemic reaction (other): Stomach gurgling, testicular pain on side of injection, neck pain stiff neck, migraine, intermittent shooting pains from left side, numbness tingling sensations hand and foot.(b)(6)

redacted (b)(6)

Release 9 — days 1–6 daily, dose 1

2021-06-11

Systemic reaction (other): Flush, sweating, night sweats (soaked shirt), continous ear ringing, neck stiffness, neck aches,

2021-06-12

Systemic reaction (other): Flush, sweats,

2021-06-13

Systemic reaction (other): Flushing, sweats

2021-06-14

Systemic reaction (other): Continued ringing in both ears. Feel flush, Day and nightsweats

2021-06-15

Systemic reaction (other): Ringing in ears, Sore Throat (New), Bleed easily, pins and needles in left lower extremities (bottom of foot) and hand Left side w/aches

2021-06-16

Systemic reaction (other): Ear ringing, tingling left hand & ball of left foot, hand tremors, red burning eyes (2 days), cold/hot sweats

Release 9 — day 7, dose 1

2021-06-19

Systemic reaction (other): Ear ringing

Release 9 — day 14, dose 1

2021-06-24

Symptoms: Swollen lymph nodes, (left) ear ringing (continued), joint pain.

Release 9 — day 21, dose 1

2021-07-01

Symptoms: Gland swelling (same side of injection) continued night sweats, continued ringing in ears.

Release 12 — 12 months, dose 1

2022-06-12

Symptoms: Continued ringing in ear. Suspected bllod clot left leg.

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	Arthralgia	✓	✓	✓
SD	Lymphadenopathy	✓	✓	✓
SD	Night sweats	✓	✓	✓
SD	Thrombosis	·	·	✓
SD	Tinnitus	✓	✓	✓
SRO	Cold sweat	✓	✓	✓
SRO	Eye irritation	✓	✓	✓
SRO	Feeling of body temperature change	✓	✓	✓
SRO	Flushing	✓	✓	✓
SRO	Gastrointestinal sounds abnormal	✓	✓	✓
SRO	Haemorrhage	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Migraine	✓	✓	✓
SRO	Musculoskeletal stiffness	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Night sweats	✓	✓	✓
SRO	Ocular hyperaemia	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Testicular pain	✓	✓	✓
SRO	Tinnitus	✓	✓	✓
SRO	Tremor	✓	✓	✓

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