2PM-15668-72213

4 vaccinations 7 coded responses 13 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 852 / AZ
Registered: 2021-04-03

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Registered dependents

PRF-27541-15037 Adult relative or friend · Male · 2021-06-14

Timeline

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

2021-02-12
Dose 1 — Moderna
2021-03-13
Dose 2 — Moderna
2021-04-03
Registered in v-safe
2021-04-03
Survey response — day 21, dose 2
MedDRA: Cautery to nose, Epistaxis — Feeling: Fair · Be unable to do your normal daily activities

Free text: Nose cauterized 4 days after vaccine. Bloody noses with huge clots. I dont know if the vaccine really had anything to do with it but today I had a nosebleed that lasted 15 months with clots that I had to spit out going down my throat.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Survey response — day 28, dose 2
MedDRA: Abdominal pain upper, Diarrhoea, Headache — Feeling: Good

Free text: Headaches Stomach cramps and diarrhea Probably not vaccine related.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-14
Survey response — 3 months, dose 2
MedDRA: Brain fog — Feeling: Fair

Free text: Brain fog and forgetting. Could be just age related. Will be visiting dr if it persists or worsens.

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

Free text: Symptoms: Vascular growth on finger in process with hand surgeon · Healthcare visit (other): In person hand specialist

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

1 call case(s)
2021-09-16
Call 1 — Left Voicemail
2021-11-04
Dose 3 — Moderna
2022-03-15
Survey response — 12 months, dose 2
MedDRA: Cough, Fatigue, Oropharyngeal pain, Pyrexia — Feeling: Fair

Free text: Fever low grade sore throat cough tired

MedDRA releases: 2024-11 · check-in free text available
2022-05-05
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-10-16
Dose 4 — Moderna
2022-11-04
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in
2022-11-04
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-06
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-11-20
Survey response — day 35, dose 4
MedDRA: Arthritis, Gait disturbance, Office visit, Pain, Ventilation/perfusion scan abnormal — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Walking pain probably arthritis Lung scan showed possible esophagus problem currently undefined until follow-up · Healthcare visit (other): Dr. Visit and endoscopy needed

MedDRA releases: 2024-11 · check-in free text available
2022-11-20
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-21
Call 2 — Left Voicemail
2022-11-21
Call 1 — Left Voicemail
2023-04-17
Survey response — 6 months, dose 4
MedDRA: Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-17
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-18
Call successful
Does not wish to fill out VAERS report
2023-04-18
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-18
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	2021-02-12	Moderna
2	2021-03-13	Moderna
3	2021-11-04	Moderna	No
4	2022-10-16	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 6 — day 21, dose 2

2021-04-03

Symptoms: Nose cauterized 4 days after vaccine. Bloody noses with huge clots. I dont know if the vaccine really had anything to do with it but today I had a nosebleed that lasted 15 months with clots that I had to spit out going down my throat.

Release 7 — day 28, dose 2

2021-04-10

Symptoms: Headaches Stomach cramps and diarrhea Probably not vaccine related.

Release 9 — 3 months, dose 2

2021-06-14

Symptoms: Brain fog and forgetting. Could be just age related. Will be visiting dr if it persists or worsens.

Release 9 — 6 months, dose 2

2021-09-11

Symptoms: Vascular growth on finger in process with hand surgeon

Healthcare visit (other): In person hand specialist

Release 11 — 12 months, dose 2

2022-03-15

Symptoms: Fever low grade sore throat cough tired

Release 12 — day 35, dose 4

2022-11-20

Symptoms: Walking pain probably arthritis Lung scan showed possible esophagus problem currently undefined until follow-up

Healthcare visit (other): Dr. Visit and endoscopy needed

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	Abdominal pain upper	✓	✓	✓
SD	Arthritis	·	·	✓
SD	Brain fog	✓	✓	✓
SD	Cautery to nose	✓	✓	✓
SD	Cough	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Epistaxis	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Gait disturbance	·	·	✓
SD	Headache	✓	✓	✓
SD	Office visit	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Vascular neoplasm	·	·	✓
SD	Ventilation/perfusion scan abnormal	·	·	✓

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