ZUK-15532-22219

4 vaccinations 9 coded responses 39 check-ins 9 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 921 / CA
Registered: 2021-01-21

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

2021-01-21
Registered in v-safe
2021-01-21
Dose 1 — Moderna
2021-01-21
Survey response — day 0, dose 1
MedDRA: Dizziness, Vision blurred — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Woozy and vision slightly blurred

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Vision blurred — Feeling: Good · Site: Pain

Free text: Slightly woozy and blurry eyed. Possibly from Tylenol?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-28
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-11
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-18
Dose 2 — Moderna
2021-02-18
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Bowel movement irregularity — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Extra BMs today but not diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-21
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Rash macular — Feeling: Good · Site: Redness · Rash, not including the immediate area around the injection site

Free text: Blotchy red area spread down over bicep. Not itchy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · Rash, not including the immediate area around the injection site

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · Rash, not including the immediate area around the injection site

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · Rash, not including the immediate area around the injection site

Adult check-in
2021-02-25
Health check-in — day 7, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-03-04
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-13
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-20
Survey response — 3 months, dose 2
MedDRA: Cough, Nasopharyngitis — Feeling: Good

Free text: Cold and mild cough,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-19
Survey response — 6 months, dose 2
MedDRA: Musculoskeletal stiffness, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Possible vertigo, stiff neck muscle. · Healthcare visit (other): Dr and MRI

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-19
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-24
Call 1 — Left Voicemail
2021-08-24
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-08
Dose 3 — Moderna
2022-02-18
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-05-09
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-07-19
Dose 4 — Moderna
2022-07-22
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2022-07-23
Survey response — days 1–6 daily, dose 4
MedDRA: Decreased appetite, Dizziness — Feeling: Poor · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: No appetite, light headed.

MedDRA releases: 2024-11 · check-in free text available
2022-07-24
Survey response — days 1–6 daily, dose 4
MedDRA: Fatigue — Feeling: Fair · Fatigue or tiredness

Free text: Tiredness only began this afternoon after grocery shopping. Otherwise it's good.

MedDRA releases: 2024-11 · check-in free text available
2022-07-25
Survey response — days 1–6 daily, dose 4
MedDRA: Arthralgia — Feeling: Good · Fatigue or tiredness

Free text: Did not have chance to report heavy joint pain on day after shot. Gone the second day after.

MedDRA releases: 2024-11 · check-in free text available
2022-07-26
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-08-02
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-08-09
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-08-16
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-08-23
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-08-30
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-10-18
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-01-17
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Moderna
2	2021-02-18	Moderna
3	2021-11-08	Moderna	No
4	2022-07-19	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 2 — day 0, dose 1

2021-01-21

Systemic reaction (other): Woozy and vision slightly blurred

Release 2 — days 1–6 daily, dose 1

2021-01-22

Systemic reaction (other): Slightly woozy and blurry eyed. Possibly from Tylenol?

Release 4 — days 1–6 daily, dose 2

2021-02-19

Systemic reaction (other): Extra BMs today but not diarrhea

2021-02-21

Systemic reaction (other): Blotchy red area spread down over bicep. Not itchy.

Release 8 — 3 months, dose 2

2021-05-20

Symptoms: Cold and mild cough,

Release 9 — 6 months, dose 2

2021-08-19

Symptoms: Possible vertigo, stiff neck muscle.

Healthcare visit (other): Dr and MRI

Release 12 — days 1–6 daily, dose 4

2022-07-23

Systemic reaction (other): No appetite, light headed.

2022-07-24

Systemic reaction (other): Tiredness only began this afternoon after grocery shopping. Otherwise it's good.

2022-07-25

Systemic reaction (other): Did not have chance to report heavy joint pain on day after shot. Gone the second day after.

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	✓	·	✓
SD	Cough	✓	✓	✓
SD	Musculoskeletal stiffness	✓	·	✓
SD	Nasopharyngitis	✓	✓	✓
SRO	Arthralgia	·	·	✓
SRO	Bowel movement irregularity	✓	✓	✓
SRO	Decreased appetite	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Fatigue	·	·	✓
SRO	Rash macular	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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