3NX-18719-47137

3 vaccinations 18 coded responses 20 check-ins 18 free-text entries 2 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 786 / TX
Registered: 2021-02-27

Relationship: Self
Race: Multiracial
Ethnicity: N/A

Timeline

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

2021-01-25
Dose 1 — Moderna
2021-02-25
Dose 2 — Moderna
2021-02-27
Registered in v-safe
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease, Procedural pain — Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Pain in surgeries from years past

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Oral mucosal blistering — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Blisters inside my mouth on the left side.(where the shot was injected.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Rhinorrhoea — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Runny nose, clear/light green

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — day 7, dose 2
MedDRA: Oral mucosal blistering — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Nausea · Be unable to do your normal daily activities

Free text: I have two mouth blisters that bleed every time I eat. I never had a mouth blister in my life. They are in the left side. where the vaccine was injected.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — day 14, dose 2
MedDRA: Genital rash, Oral mucosal blistering — Feeling: Fair · Be unable to do your normal daily activities

Free text: I have still two blisters in my mouth, if I eat cashews or something hard they pop up and bleed. Also, two days ago I developed a rash in my my private bottom.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — day 21, dose 2
MedDRA: Rash, Skin discolouration — Feeling: Fair · Be unable to do your normal daily activities

Free text: I have purple 2 inches spots on my legs, also my private bottom part is with a small rash

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Survey response — day 28, dose 2
MedDRA: Oral disorder, Saliva altered — Feeling: Fair · Be unable to do your normal daily activities

Free text: Ampules in my mouth and thick saliva

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — day 35, dose 2
MedDRA: Increased viscosity of upper respiratory secretion, Skin discolouration — Feeling: Good · Be unable to do your normal daily activities

Free text: Thick saliva, purple spots on my skin.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-29
Survey response — 3 months, dose 2
MedDRA: Nervous system disorder, Oral mucosal blistering, Poor quality sleep — Feeling: Good · Be unable to do your normal daily activities

Free text: Mouth blisters when drinking coffee or eating spicy foods. It didnt happen before the Vacinne .Bad sleep and my nervous system is altered.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-26
Survey response — 6 months, dose 2
MedDRA: Blood blister, Condition aggravated, Oral mucosal blistering, Pre-existing disease — Feeling: Good · 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: Mouth blisters every few weeks, they dont get infected but the bleed a lot. It takes like foour days to dissolve.Also my varicose veins came back I didnt have the blisters appearance all my life. The veins yes, but not like for them to appea

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-26
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-02
Call 1 — Could Not Reach Participant
2021-09-09
Call 2 — Could Not Reach Participant
2021-11-05
Dose 3 — Moderna
2021-11-06
Survey response — days 1–6 daily, dose 3
MedDRA: Dyskinesia — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Parts of my body jump by themselves.

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Survey response — days 1–6 daily, dose 3
MedDRA: Skin discolouration — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to do your normal daily activities

Free text: Purple and green 1" to 2" round spots on my legs

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Survey response — days 1–6 daily, dose 3
MedDRA: Thrombosis — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school

Free text: Blood clots, green, blue and purple. 1" - 2" size

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-28
Survey response — day 21, dose 3
MedDRA: Asthenia, Office visit — 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

Free text: Symptoms: Weakness, not even vitamin D3 gives me energy · Healthcare visit (other): Visit in person

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Report sent to call center — day 21, dose 3
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 · 1 call case(s)
2021-11-30
Call 1 — Left Voicemail
2021-12-05
Survey response — day 28, dose 3
MedDRA: Asthenia, Nausea, Somnolence — Feeling: Fair · Be unable to do your normal daily activities

Free text: Nausea, sleepiness and lack of energy

MedDRA releases: 2024-11 · check-in free text available
2021-12-12
Survey response — day 35, dose 3
MedDRA: Asthenia, Insomnia, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities

Free text: Terrible sleep needs, weakness and low drive.

MedDRA releases: 2024-11 · check-in free text available
2022-02-04
Survey response — 3 months, dose 3
MedDRA: Nervousness, Skin discolouration, Tic — Feeling: Fair

Free text: Purple spots and nervous ticks

MedDRA releases: 2024-11 · check-in free text available
2022-05-09
Survey response — 6 months, dose 3
MedDRA: Fatigue, Skin discolouration, Vasodilatation — Feeling: Fair · Be unable to do your normal daily activities

Free text: Purple sports on my skin, veins more pronunciated, always tired

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-25	Moderna
2	2021-02-25	Moderna
3	2021-11-05	Moderna	No

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-03-01

Systemic reaction (other): Pain in surgeries from years past

2021-03-02

Systemic reaction (other): Blisters inside my mouth on the left side.(where the shot was injected.

Release 5 — days 1–6 daily, dose 2

2021-03-03

Systemic reaction (other): Runny nose, clear/light green

Release 5 — day 7, dose 2

2021-03-04

Systemic reaction (other): I have two mouth blisters that bleed every time I eat. I never had a mouth blister in my life. They are in the left side. where the vaccine was injected.

Release 5 — day 14, dose 2

2021-03-11

Symptoms: I have still two blisters in my mouth, if I eat cashews or something hard they pop up and bleed. Also, two days ago I developed a rash in my my private bottom.

Release 6 — day 21, dose 2

2021-03-20

Symptoms: I have purple 2 inches spots on my legs, also my private bottom part is with a small rash

Release 6 — day 28, dose 2

2021-03-25

Symptoms: Ampules in my mouth and thick saliva

Release 6 — day 35, dose 2

2021-04-01

Symptoms: Thick saliva, purple spots on my skin.

Release 8 — 3 months, dose 2

2021-05-29

Symptoms: Mouth blisters when drinking coffee or eating spicy foods. It didnt happen before the Vacinne .Bad sleep and my nervous system is altered.

Release 9 — 6 months, dose 2

2021-08-26

Symptoms: Mouth blisters every few weeks, they dont get infected but the bleed a lot. It takes like foour days to dissolve.Also my varicose veins came back I didnt have the blisters appearance all my life. The veins yes, but not like for them to appea

Release 10 — days 1–6 daily, dose 3

2021-11-06

Systemic reaction (other): Parts of my body jump by themselves.

2021-11-08

Systemic reaction (other): Purple and green 1" to 2" round spots on my legs

2021-11-09

Systemic reaction (other): Blood clots, green, blue and purple. 1" - 2" size

Release 10 — day 21, dose 3

2021-11-28

Symptoms: Weakness, not even vitamin D3 gives me energy

Healthcare visit (other): Visit in person

Release 10 — day 28, dose 3

2021-12-05

Symptoms: Nausea, sleepiness and lack of energy

Release 10 — day 35, dose 3

2021-12-12

Symptoms: Terrible sleep needs, weakness and low drive.

Release 11 — 3 months, dose 3

2022-02-04

Symptoms: Purple spots and nervous ticks

Release 11 — 6 months, dose 3

2022-05-09

Symptoms: Purple sports on my skin, veins more pronunciated, always tired

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	Asthenia	·	·	✓
SD	Blood blister	✓	·	✓
SD	Condition aggravated	✓	·	✓
SD	Fatigue	·	·	✓
SD	Genital rash	✓	✓	✓
SD	Increased viscosity of upper respiratory secretion	✓	✓	✓
SD	Insomnia	·	·	✓
SD	Nausea	·	·	✓
SD	Nervous system disorder	✓	✓	✓
SD	Nervousness	·	·	✓
SD	Oral disorder	✓	✓	✓
SD	Oral mucosal blistering	✓	✓	✓
SD	Poor quality sleep	✓	✓	✓
SD	Pre-existing disease	✓	·	✓
SD	Rash	✓	✓	✓
SD	Saliva altered	✓	✓	✓
SD	Skin discolouration	✓	✓	✓
SD	Somnolence	·	·	✓
SD	Tic	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Vasodilatation	·	·	✓
SRO	Dyskinesia	·	·	✓
SRO	Oral mucosal blistering	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Procedural pain	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Skin discolouration	·	·	✓
SRO	Thrombosis	·	·	✓

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