3XM-32665-09445

2 vaccinations 13 coded responses 21 check-ins 13 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 234 / VA
Registered: 2021-02-02

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

2021-02-02
Registered in v-safe
2021-02-02
Dose 1 — Moderna
2021-02-02
Health check-in — day 0, dose 1
Feeling: Fair · Headache · Be unable to do your normal daily activities

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-04
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: Itching at different spots on my skin.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-02-07
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling abnormal, Pruritus — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Some itching of skin. I also have experienced a kind of brain fog for about three days. I didnt realize it, but it has been persistent.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Axillary mass, Lymphadenopathy — Feeling: Fair

Free text: Swollen lumps in armpit. I am thinking lymph nodes.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — day 7, dose 1
MedDRA: Lymphadenopathy — Feeling: Good

Free text: Very Swollen Lymph Nodes in Armpit on arm that had the shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-02
Dose 2 — Moderna
2021-03-02
Survey response — day 0, dose 2
MedDRA: Lymph node pain — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Continued lymph node pain in groin. Had that from first shot.

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: Tongue ulceration — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Sore developed on tongue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-03-05
Survey response — days 1–6 daily, dose 2
MedDRA: Lymph node pain, Neck pain — Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches

Free text: Lymph node pain in groin. Burning and pain in neck on side of shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Visual impairment — Feeling: Fair · Site: Redness · Fatigue or tiredness · Be unable to work

Free text: Severe Visual problems. Disturbances in vision. I suspect inflammation of blood vessels in back of eye.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — day 7, dose 2
MedDRA: Ophthalmic migraine — Feeling: Fair · Headache · Be unable to work

Free text: Diagnosed with Ocular Migraine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — day 14, dose 2
MedDRA: Adverse reaction, Eye inflammation, Eye pain, Metamorphopsia, Office visit, Ophthalmic migraine — Feeling: Fair · Be unable to work, 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: I was diagnosed by retinal specialist as having a post-vaccine ocular adverse reaction to the second shot that resulted in an ocular migraine and inflammation of both eyes causing bad visual distortion and pain. I am still experiencing eye pain. · Healthcare visit (other): Two doctors office visits in person.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Report sent to call center — day 14, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-25
Survey response — day 21, dose 2
MedDRA: Injection site pain, Lymph node pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Lymph nodes in left groin hurt really bad. I had my shot on my left side. I had pain in that area from the shot that had subsided, but its back now. It hurts pretty bad!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — day 28, dose 2
MedDRA: Eye pain, Lymph node pain, Migraine — Feeling: Fair · Be unable to do your normal daily activities

Free text: Bad migraine headaches, eye pain, lymph node pain. Had to spend Sunday in bed.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — day 35, dose 2
MedDRA: Eye inflammation, Eye pain, Headache, Migraine, Ophthalmic migraine, Vitreous floaters — Feeling: Fair · Be unable to do your normal daily activities

Free text: Continuing headaches and migraines very day. I have continuing eye pain. I was diagnosed with a severe adverse reaction to the second shot. Diagnosed with eye inflammation, an ocular migraine, and increased migraines. Have permanent new eye floaters.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-08-31
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-03-03
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-02	Moderna
2	2021-03-02	Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-04

Systemic reaction (other): Itching at different spots on my skin.

2021-02-07

Systemic reaction (other): Some itching of skin. I also have experienced a kind of brain fog for about three days. I didnt realize it, but it has been persistent.

2021-02-08

Systemic reaction (other): Swollen lumps in armpit. I am thinking lymph nodes.

Release 3 — day 7, dose 1

2021-02-09

Systemic reaction (other): Very Swollen Lymph Nodes in Armpit on arm that had the shot.

Release 4 — day 0, dose 2

2021-03-02

Systemic reaction (other): Continued lymph node pain in groin. Had that from first shot.

Release 5 — days 1–6 daily, dose 2

2021-03-03

Systemic reaction (other): Sore developed on tongue.

2021-03-05

Systemic reaction (other): Lymph node pain in groin. Burning and pain in neck on side of shot.

2021-03-07

Systemic reaction (other): Severe Visual problems. Disturbances in vision. I suspect inflammation of blood vessels in back of eye.

Release 5 — day 7, dose 2

2021-03-09

Systemic reaction (other): Diagnosed with Ocular Migraine

Release 5 — day 14, dose 2

2021-03-18

Symptoms: I was diagnosed by retinal specialist as having a post-vaccine ocular adverse reaction to the second shot that resulted in an ocular migraine and inflammation of both eyes causing bad visual distortion and pain. I am still experiencing eye pain.

Healthcare visit (other): Two doctors office visits in person.

Release 6 — day 21, dose 2

2021-03-25

Symptoms: Lymph nodes in left groin hurt really bad. I had my shot on my left side. I had pain in that area from the shot that had subsided, but its back now. It hurts pretty bad!

Release 6 — day 28, dose 2

2021-03-30

Symptoms: Bad migraine headaches, eye pain, lymph node pain. Had to spend Sunday in bed.

Release 7 — day 35, dose 2

2021-04-06

Symptoms: Continuing headaches and migraines very day. I have continuing eye pain. I was diagnosed with a severe adverse reaction to the second shot. Diagnosed with eye inflammation, an ocular migraine, and increased migraines. Have permanent new eye floaters. cut off by CDC

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	Adverse reaction	✓	✓	✓
SD	Eye inflammation	✓	✓	✓
SD	Eye pain	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Lymph node pain	✓	✓	✓
SD	Metamorphopsia	✓	✓	✓
SD	Migraine	✓	✓	✓
SD	Ophthalmic migraine	✓	✓	✓
SD	Vitreous floaters	✓	✓	✓
SRO	Axillary mass	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Lymph node pain	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Ophthalmic migraine	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Tongue ulceration	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

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