28V-17722-89852

3 vaccinations 10 coded responses 16 check-ins 10 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 762 / TX
Registered: 2021-10-16

Relationship: Self
Race: American Indian or Alaska Native
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-28
Dose 1 — Moderna
2021-02-25
Dose 2 — Moderna
2021-10-16
Registered in v-safe
2022-02-25
Dose 3 — Moderna
2022-02-25
Survey response — day 0, dose 3
MedDRA: Dyspnoea, General physical health deterioration, Loss of personal independence in daily activities — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Systemic reaction (other): I have shortness of breath, I have trouble with my daily activities such as grocery shopping putting groceries away cleaning my home. I wish I would've known what the vaccine was gonna do to my life! I was encouraged by Dr. Birx and Dr. Fauci . · Healthcare visit (other): My health has deteriorated I want to be compensated for the jerk duration of my health!

MedDRA releases: 2024-11 · check-in free text available
2022-02-25
Survey response — 12 months, dose 2
MedDRA: General physical health deterioration, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities

Free text: Since getting the vaccine my health has declined tenfold. I have asthma which I never had before and I'm 62 years old I have allergies which I never had before. My health is on the decline every since I had the second shot. I need to be compensated.

MedDRA releases: 2024-11 · check-in free text available
2022-02-25
Report sent to call center — day 0, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-02-26
Survey response — days 1–6 daily, dose 3
MedDRA: Aortic thrombosis, Emergency care — Feeling: Poor · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I found out this week while in the emergency room that I have a blood clot in my upper abdomen.

MedDRA releases: 2024-11 · check-in free text available
2022-02-26
Report sent to call center — days 1–6 daily, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-02-27
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2022-02-28
Survey response — days 1–6 daily, dose 3
MedDRA: Aortic thrombosis — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · 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: I was put on Eliquis, to thin the blood from the thrombosis in the abdominal aorta. Also, a referral to a Vascular surgeon, for this issue and another abdominal aorta. All of this I believe is contributed to the Merdona second vaccine

MedDRA releases: 2024-11 · check-in free text available
2022-02-28
Report sent to call center — days 1–6 daily, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-01
Survey response — days 1–6 daily, dose 3
MedDRA: Asthma, Dyspnoea, Hypersensitivity — Feeling: Poor · Headache, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Shortness of breath. After my last vaccine I developed Asthma and allergies.

MedDRA releases: 2024-11 · check-in free text available
2022-03-02
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-03-03
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue, Malaise — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: (b)(6) The fatigue is really bad today.

MedDRA releases: 2024-11 · check-in free text available
2022-03-03
Call 1 — Could Not Reach Participant
2022-03-04
Survey response — day 7, dose 3
MedDRA: Fatigue — Feeling: Fair · Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Extremely fatigued. After sleeping 8 hours.

MedDRA releases: 2024-11 · check-in free text available
2022-03-08
Call successful
Participant prefers to complete VAERS report online
2022-03-12
Survey response — day 14, dose 3
MedDRA: Bedridden, Fatigue, Loss of personal independence in daily activities — Feeling: Poor · Be unable to do your normal daily activities

Free text: I'm totally exhausted!! I've been bed ridden since 2/25/2021. My life has change dramatically. Im unable to do the things I love. Taking care of my home and disabled child. Getting dressed is a chore!! Someone should have to pay for this!

MedDRA releases: 2024-11 · check-in free text available
2022-03-20
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-03-25
Survey response — day 28, dose 3
MedDRA: Fatigue — Feeling: Poor · Be unable to do your normal daily activities

Free text: Extreme Fatigue.

MedDRA releases: 2024-11 · check-in free text available
2022-04-01
Health check-in — day 35, dose 3
Feeling: Poor

Adult check-in
2022-04-08
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-05-27
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-08-26
Survey response — 6 months, dose 3
MedDRA: C-reactive protein increased, Office visit — Feeling: Poor · Be unable to do your normal daily activities

Free text: My gastroenterologist recommended I have a colon resection done within the next few months. I also have a relative risk for future cardiac event, do to a high C-Reactive Protein, Cardiac.

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-28	Moderna	No
2	2021-02-25	Moderna	No
3	2022-02-25	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 11 — 12 months, dose 2

2022-02-25

Symptoms: Since getting the vaccine my health has declined tenfold. I have asthma which I never had before and I'm 62 years old I have allergies which I never had before. My health is on the decline every since I had the second shot. I need to be compensated. cut off by CDC

Release 11 — day 0, dose 3

2022-02-25

Systemic reaction (other): I have shortness of breath, I have trouble with my daily activities such as grocery shopping putting groceries away cleaning my home. I wish I would've known what the vaccine was gonna do to my life! I was encouraged by Dr. Birx and Dr. Fauci .

Healthcare visit (other): My health has deteriorated I want to be compensated for the jerk duration of my health!

Release 11 — days 1–6 daily, dose 3

2022-02-26

Systemic reaction (other): I found out this week while in the emergency room that I have a blood clot in my upper abdomen.

2022-02-28

Healthcare visit (other): I was put on Eliquis, to thin the blood from the thrombosis in the abdominal aorta. Also, a referral to a Vascular surgeon, for this issue and another abdominal aorta. All of this I believe is contributed to the Merdona second vaccine

2022-03-01

Systemic reaction (other): Shortness of breath. After my last vaccine I developed Asthma and allergies.

2022-03-03

Systemic reaction (other): (b)(6) The fatigue is really bad today.

redacted (b)(6)

Release 11 — day 7, dose 3

2022-03-04

Systemic reaction (other): Extremely fatigued. After sleeping 8 hours.

Release 11 — day 14, dose 3

2022-03-12

Symptoms: I'm totally exhausted!! I've been bed ridden since 2/25/2021. My life has change dramatically. Im unable to do the things I love. Taking care of my home and disabled child. Getting dressed is a chore!! Someone should have to pay for this!

Release 11 — day 28, dose 3

2022-03-25

Symptoms: Extreme Fatigue.

Release 12 — 6 months, dose 3

2022-08-26

Symptoms: My gastroenterologist recommended I have a colon resection done within the next few months. I also have a relative risk for future cardiac event, do to a high C-Reactive Protein, Cardiac.

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	Aortic thrombosis	·	·	✓
HCVO	General physical health deterioration	·	·	✓
SD	Bedridden	·	·	✓
SD	C-reactive protein increased	·	·	✓
SD	Fatigue	·	·	✓
SD	General physical health deterioration	·	·	✓
SD	Loss of personal independence in daily activities	·	·	✓
SD	Office visit	·	·	✓
SD	Pre-existing disease	·	·	✓
SRO	Aortic thrombosis	·	·	✓
SRO	Asthma	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Emergency care	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Hypersensitivity	·	·	✓
SRO	Loss of personal independence in daily activities	·	·	✓
SRO	Malaise	·	·	✓

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