3X3-56108-73047

3 vaccinations 6 coded responses 15 check-ins 6 free-text entries 4 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 863 / AZ
Registered: 2021-11-21

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

2021-02-13
Dose 1 — Moderna
2021-03-13
Dose 2 — Moderna
2021-11-20
Dose 3 — Moderna
2021-11-21
Registered in v-safe
2021-11-21
Survey response — days 1–6 daily, dose 3
MedDRA: Dehydration — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Nausea · Be unable to do your normal daily activities

Free text: Dehydration (I drink 100 ounces of fluids per day)

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Survey response — days 1–6 daily, dose 3
MedDRA: Parosmia, Photophobia — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Yesterday I had about 5 hours of odd olfactory issues. Strange smells. Today bright lights effecting my vision.

MedDRA releases: 2024-11 · check-in free text available
2021-11-23
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-11-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Joint pains

Adult check-in
2021-11-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-27
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-04
Survey response — day 14, dose 3
MedDRA: Dry eye, Eye irritation, Office visit, Photophobia — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Continuing issue with eyes around bright or reflective light. Dry irritated eyes · Healthcare visit (other): Ophthalmologist office

MedDRA releases: 2024-11 · check-in free text available
2021-12-04
Report sent to call center — day 14, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-08
Call 1 — Left Voicemail
2021-12-11
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-18
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-25
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-01
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-19
Survey response — 3 months, dose 3
MedDRA: Brain fog, Photophobia — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Extreme light sensitivity and brain fog

MedDRA releases: 2024-11 · check-in free text available
2022-02-19
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-03-02
Call 1 — Left Voicemail
2022-05-21
Survey response — 6 months, dose 3
MedDRA: Hypertension, Office visit — Feeling: Fair · 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: Symptoms: Hypertension · Healthcare visit (other): Doctors office/EKG Echocardiogram

MedDRA releases: 2024-11 · check-in free text available
2022-05-21
Report sent to call center — 6 months, 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)
2022-05-23
Call successful
Participant prefers to complete VAERS report online
2022-05-23
Call successful
Participant prefers to complete VAERS report online
2022-05-23
Call successful
Participant prefers to complete VAERS report online
2022-11-20
Survey response — 12 months, dose 3
MedDRA: COVID-19, Office visit — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Active Covid infection starting 11/11/22 to current. · Healthcare visit (other): PCP

MedDRA releases: 2024-11 · check-in free text available
2022-11-20
Report sent to call center — 12 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-21
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-13	Moderna	No
2	2021-03-13	Moderna	No
3	2021-11-20	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 10 — days 1–6 daily, dose 3

2021-11-21

Systemic reaction (other): Dehydration (I drink 100 ounces of fluids per day)

2021-11-22

Systemic reaction (other): Yesterday I had about 5 hours of odd olfactory issues. Strange smells. Today bright lights effecting my vision.

Release 10 — day 14, dose 3

2021-12-04

Symptoms: Continuing issue with eyes around bright or reflective light. Dry irritated eyes

Healthcare visit (other): Ophthalmologist office

Release 11 — 3 months, dose 3

2022-02-19

Symptoms: Extreme light sensitivity and brain fog

Release 11 — 6 months, dose 3

2022-05-21

Symptoms: Hypertension

Healthcare visit (other): Doctors office/EKG Echocardiogram

Release 12 — 12 months, dose 3

2022-11-20

Symptoms: Active Covid infection starting 11/11/22 to current.

Healthcare visit (other): PCP

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	Brain fog	·	·	✓
SD	COVID-19	·	·	✓
SD	Dry eye	·	·	✓
SD	Eye irritation	·	·	✓
SD	Hypertension	·	·	✓
SD	Photophobia	·	·	✓
SRO	Dehydration	·	·	✓
SRO	Parosmia	·	·	✓
SRO	Photophobia	·	·	✓

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