3TZ-17788-22771

1 vaccination 6 coded responses 8 check-ins 6 free-text entries 4 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 347 / FL
Registered: 2021-05-17

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

2021-05-17
Registered in v-safe
2021-05-17
Dose 1 — Moderna
2021-05-17
Survey response — day 0, dose 1
MedDRA: Pre-existing disease — Feeling: Poor · Site: Swelling, Itching · Vomiting · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: I had a typical anaphylaxis reaction. Throat tight , coughing a lot with a feeling of swelling in my chest. Mri has

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-17
Report sent to call center — day 0, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-20
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Poor · Site: Pain, Swelling, Itching · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Still dealing with breathing problems. I just finished with explaining whats going on

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea, Office visit — Feeling: Poor · Site: Redness, Swelling · Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Still having issues with breathing. Have to use the nebulizer wirh steroids to help wirh normal breathing · Healthcare visit (other): Regular dr visits

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-22
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Some breathing issues but much better today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-24
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-11-15
Survey response — 6 months, dose 1
MedDRA: Deafness, Headache, Office visit, Pre-existing disease, Tinnitus — Feeling: Poor · Be unable to work or attend school, 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 had a pop sound in my head that turns into extreme pain and loss of hearing. Thing s actually got worse. I kept getting the attacks. Told to go to Er my my dr. They did all the tests nothing shows but I have a very bad neck as not an aneurisms.

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Report sent to call center — 6 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · 1 call case(s)
2021-11-16
Call successful
Participant prefers to complete VAERS report online
2022-05-18
Survey response — 12 months, dose 1
MedDRA: Anaphylactic reaction, Aneurysm, Hospitalisation, Malaise, Surgery — Feeling: Fair · Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: An aneurysm. Strange I got this out of nowhere. Seems ever since I got that vaccine I have not felt well. However I am vaccinated even though I had anaphylaxis and had to be hospitalized. · Healthcare visit (other): Surgery for the aneurysm at (b)(6)

MedDRA releases: 2024-11 · check-in free text available
2022-05-18
Report sent to call center — 12 months, dose 1
Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-05-19
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	2021-05-17	Moderna

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 8 — day 0, dose 1

2021-05-17

Systemic reaction (other): I had a typical anaphylaxis reaction. Throat tight , coughing a lot with a feeling of swelling in my chest. Mri has

Release 8 — days 1–6 daily, dose 1

2021-05-20

Systemic reaction (other): Still dealing with breathing problems. I just finished with explaining whats going on

2021-05-21

Systemic reaction (other): Still having issues with breathing. Have to use the nebulizer wirh steroids to help wirh normal breathing

Healthcare visit (other): Regular dr visits

2021-05-22

Systemic reaction (other): Some breathing issues but much better today.

Release 10 — 6 months, dose 1

2021-11-15

Symptoms: I had a pop sound in my head that turns into extreme pain and loss of hearing. Thing s actually got worse. I kept getting the attacks. Told to go to Er my my dr. They did all the tests nothing shows but I have a very bad neck as not an aneurisms. cut off by CDC

Release 11 — 12 months, dose 1

2022-05-18

Symptoms: An aneurysm. Strange I got this out of nowhere. Seems ever since I got that vaccine I have not felt well. However I am vaccinated even though I had anaphylaxis and had to be hospitalized.

Healthcare visit (other): Surgery for the aneurysm at (b)(6)

redacted (b)(6)

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	Aneurysm	·	·	✓
HCVO	Office visit	✓	✓	✓
HCVO	Surgery	·	·	✓
SD	Anaphylactic reaction	·	·	✓
SD	Aneurysm	·	·	✓
SD	Deafness	·	·	✓
SD	Headache	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Malaise	·	·	✓
SD	Office visit	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Tinnitus	·	·	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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