ZTT-15203-48015

4 vaccinations 12 coded responses 37 check-ins 12 free-text entries 1 call case

Sex: Male
Age at first dose: 41-45
ZIP prefix: 193 / PA
Registered: 2021-04-01

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

PLE-46341-27878 Child or adolescent in my care · Male · 2022-10-08

Timeline

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

2021-04-01
Registered in v-safe
2021-04-01
Dose 1 — Moderna
2021-04-01
Survey response — day 0, dose 1
MedDRA: Paraesthesia — Feeling: Fair · Site: Pain · Chills

Free text: Tingling down injected arm to fingers and around jaw

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

Free text: Functionally limiting arm pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — days 1–6 daily, dose 1
MedDRA: Abnormal faeces, Gastrointestinal sounds abnormal — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Abnormal bowels, but not diarrhea

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

Free text: Tinnitus (intermittent, present yesterday as well)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness, Diarrhea

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-08
Survey response — day 7, dose 1
MedDRA: Tinnitus — Feeling: Good

Free text: High frequency intermittent tinnitus, unilateral and alternating sides

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — day 14, dose 1
MedDRA: Pain in extremity — Feeling: Good · Be unable to do your normal daily activities

Free text: Increase in arm pain / injected side (may not be related)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Survey response — day 21, dose 1
MedDRA: Effusion, Joint effusion, Pain in extremity, Radial head dislocation — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Extreme arm pain (ended up subluxing elbow, reduced and went for xray after pain continued, effussion seen)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-29
Dose 2 — Moderna
2021-04-29
Health check-in — day 0, dose 2
Feeling: Fair · None

Adult check-in
2021-04-30
Survey response — days 1–6 daily, dose 2
MedDRA: Tinnitus — Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Tinnitus

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-05-02
Survey response — days 1–6 daily, dose 2
MedDRA: Tinnitus — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Intermittent tinnitus

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Survey response — days 1–6 daily, dose 2
MedDRA: Tinnitus — Feeling: Fair · Fever · Joint pains, Muscle or body aches

Free text: Tinnitus, internittent

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Survey response — days 1–6 daily, dose 2
MedDRA: Tinnitus — Feeling: Fair · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Free text: Tinnitus

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Survey response — days 1–6 daily, dose 2
MedDRA: Tinnitus — Feeling: Fair · Joint pains, Muscle or body aches

Free text: Tinnitus

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Health check-in — day 7, dose 2
Feeling: Fair · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-13
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-20
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-27
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-06-03
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-06-12
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-29
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-10-28
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-01-14
Dose 3 — Pfizer-BioNTech
2022-04-04
Call successful
Does not wish to fill out VAERS report
2022-04-29
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-10-07
Dose 4 — Pfizer-BioNTech
2022-10-08
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2022-10-09
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2022-10-10
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Muscle or body aches

Adult check-in
2022-10-11
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Muscle or body aches

Adult check-in
2022-10-12
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Muscle or body aches

Adult check-in
2022-10-13
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Muscle or body aches

Adult check-in
2022-10-14
Health check-in — day 7, dose 4
Feeling: Fair · Muscle or body aches

Adult check-in
2022-10-21
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-11
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-18
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-04-09
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-01	Moderna
2	2021-04-29	Moderna
3	2022-01-14	Pfizer-BioNTech	No
4	2022-10-07	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-22	Successful 2022-04-04	Does not wish to fill out VAERS report

Free text

Release 6 — day 0, dose 1

2021-04-01

Systemic reaction (other): Tingling down injected arm to fingers and around jaw

Release 6 — days 1–6 daily, dose 1

2021-04-02

Systemic reaction (other): Functionally limiting arm pain

2021-04-03

Systemic reaction (other): Abnormal bowels, but not diarrhea

2021-04-04

Systemic reaction (other): Tinnitus (intermittent, present yesterday as well)

Release 7 — day 7, dose 1

2021-04-08

Systemic reaction (other): High frequency intermittent tinnitus, unilateral and alternating sides

Release 7 — day 14, dose 1

2021-04-15

Symptoms: Increase in arm pain / injected side (may not be related)

Release 7 — day 21, dose 1

2021-04-22

Symptoms: Extreme arm pain (ended up subluxing elbow, reduced and went for xray after pain continued, effussion seen)

Release 8 — days 1–6 daily, dose 2

2021-04-30

Systemic reaction (other): Tinnitus

2021-05-02

Systemic reaction (other): Intermittent tinnitus

2021-05-03

Systemic reaction (other): Tinnitus, internittent

2021-05-04

Systemic reaction (other): Tinnitus

2021-05-05

Systemic reaction (other): Tinnitus

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	Effusion	○	✓	○
SD	Joint effusion	✓	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Radial head dislocation	✓	✓	✓
SRO	Abnormal faeces	✓	·	✓
SRO	Gastrointestinal sounds abnormal	○	✓	○
SRO	Pain in extremity	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Tinnitus	✓	✓	✓

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