3XM-34664-12288

5 vaccinations 11 coded responses 23 check-ins 8 free-text entries 10 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 752 / TX
Registered: 2021-02-10

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

2021-01-29
Dose 1 — Moderna
2021-02-10
Registered in v-safe
2021-02-10
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · Joint pains · Be unable to do your normal daily activities

Adult check-in
2021-02-12
Survey response — day 14, dose 1
MedDRA: Diarrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-28
Survey response — day 28, dose 1
MedDRA: Cough, Dyspnoea, Lacrimation increased, Oropharyngeal pain, Sneezing, Wheezing — Feeling: Poor · Be unable to work, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Sore throat, cough, wheezing, difficulty breathing, sneezing, watering eyes.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Report sent to call center — day 28, dose 1
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-04
Dose 2 — Moderna
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Joint pains, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Adult check-in
2021-03-07
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing condition improved — Feeling: Poor · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: flare up of psoriatic arthritis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Joint pains, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Adult check-in
2021-03-10
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-11
Health check-in — day 7, dose 2
Feeling: Poor · Joint pains, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-03-18
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-25
Survey response — day 21, dose 2
MedDRA: Arthralgia — Feeling: Fair · Be unable to work, 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: Joint pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Report sent to call center — day 21, 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)
2021-04-02
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-10
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-18
Survey response — day 42, dose 2
MedDRA: Lymphadenopathy — Feeling: Fair · Be unable to work, 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: Swollen lymph nodes in groin and leg.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-18
Report sent to call center — day 42, 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)
2021-06-08
Survey response — 3 months, dose 2
MedDRA: Abdominal pain upper, Emergency care, Headache, Hospitalisation, Mass, Musculoskeletal chest pain, Peptic ulcer, Tenderness — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Was admitted to hospital for intractable headache. Lump/mass in thigh, for which an excision biopsy is scheduled. Rib/stomach pain/tenderness. Peptic ulcers. · Healthcare visit (other): Picked up by ambulance. Scheduled for upcoming surgery/biopsy at hospital.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-08
Report sent to call center — 3 months, 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)
2021-08-02
Dose 3 — Moderna
2021-09-05
Call 2 — Left Voicemail
2021-09-17
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-11-01
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-01-17
Dose 4 — Moderna
2022-01-31
Survey response — 6 months, dose 3
MedDRA: Diplopia, Hypoaesthesia eye, Hypoaesthesia oral, Intranasal hypoaesthesia — 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 · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Numbness of lips, tongue, bottom of nose, and left eye socket. Double vision, especially in left eye.

MedDRA releases: 2024-11 · check-in free text available
2022-01-31
Report sent to call center — 6 months, 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 · Emergency room or emergency department visit · 1 call case(s)
2022-02-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-02
Survey response — 12 months, dose 3
MedDRA: Chromaturia, Eye disorder, Peripheral swelling, Unevaluable event, Urine abnormality — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Symptoms: Swollen legs, yellow frothy urine, extreme bags under eyes upon waking · Healthcare visit (other): Haven't been able to get an appointment yet but it will be with a regular family care practitioner

MedDRA releases: 2024-11 · check-in free text available
2022-08-02
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-08-03
Call 1 — Left Voicemail
2022-08-03
Call 1 — Left Voicemail
2022-08-03
Call 1 — Left Voicemail
2022-08-03
Call 1 — Left Voicemail
2022-08-03
Call 1 — Left Voicemail
2022-08-03
Call 1 — Left Voicemail
2022-12-27
Dose 5 — Moderna
2023-01-01
Survey response — days 1–6 daily, dose 5
MedDRA: Chest pain, Neck pain, Pain in extremity, Pain of skin, Rash, Spinal pain, Swelling — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-01-28
Survey response — day 28, dose 5
MedDRA: COVID-19, Influenza, Rash pruritic — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-01-28
Report sent to call center — day 28, dose 5
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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-01-30
Call 1 — Requested Callback
2023-01-30
Callback requested for
02:00PM ET
2023-01-30
Call successful
Participant prefers to complete VAERS report online
2023-01-30
Call successful
Participant prefers to complete VAERS report online
2023-01-30
Call successful
Participant prefers to complete VAERS report online
2023-01-31
Health check-in — day 35, dose 5
Feeling: Poor

Adult check-in
2023-02-07
Survey response — day 42, dose 5
MedDRA: Confusional state, Mental impairment, Pulmonary oedema, Unevaluable event — 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

MedDRA releases: 2024-11
2023-02-07
Report sent to call center — day 42, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2023-02-08
Call 1 — Left Voicemail
2023-06-28
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-29	Moderna
2	2021-03-04	Moderna
3	2021-08-02	Moderna	No
4	2022-01-17	Moderna	No
5	2022-12-27	Moderna	No

Call center

10 call center cases

9 successful · 1 unsuccessful

4 waits over 3 months for a first call

See the call center timeline

Free text

Release 4 — day 14, dose 1

2021-02-12

Symptoms: Diarrhea

Release 4 — day 28, dose 1

2021-02-28

Symptoms: Sore throat, cough, wheezing, difficulty breathing, sneezing, watering eyes.

Release 5 — days 1–6 daily, dose 2

2021-03-08

Systemic reaction (other): flare up of psoriatic arthritis

Release 6 — day 21, dose 2

2021-03-25

Symptoms: Joint pain

Release 7 — day 42, dose 2

2021-04-18

Symptoms: Swollen lymph nodes in groin and leg.

Release 8 — 3 months, dose 2

2021-06-08

Symptoms: Was admitted to hospital for intractable headache. Lump/mass in thigh, for which an excision biopsy is scheduled. Rib/stomach pain/tenderness. Peptic ulcers.

Healthcare visit (other): Picked up by ambulance. Scheduled for upcoming surgery/biopsy at hospital.

Release 11 — 6 months, dose 3

2022-01-31

Symptoms: Numbness of lips, tongue, bottom of nose, and left eye socket. Double vision, especially in left eye.

Release 12 — 12 months, dose 3

2022-08-02

Symptoms: Swollen legs, yellow frothy urine, extreme bags under eyes upon waking

Healthcare visit (other): Haven't been able to get an appointment yet but it will be with a regular family care practitioner

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	Emergency care	✓	✓	✓
HCVO	Unevaluable event	·	·	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Chromaturia	·	·	✓
SD	Confusional state	·	·	✓
SD	Cough	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Diplopia	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Eye disorder	·	·	✓
SD	Headache	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Hypoaesthesia eye	·	·	✓
SD	Hypoaesthesia oral	·	·	✓
SD	Influenza	·	·	✓
SD	Intranasal hypoaesthesia	·	·	✓
SD	Lacrimation increased	✓	✓	✓
SD	Lymphadenopathy	✓	✓	✓
SD	Mass	✓	✓	✓
SD	Mental impairment	·	·	✓
SD	Musculoskeletal chest pain	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Peptic ulcer	✓	✓	✓
SD	Peripheral swelling	·	·	✓
SD	Pulmonary oedema	·	·	✓
SD	Rash pruritic	·	·	✓
SD	Sneezing	✓	✓	✓
SD	Tenderness	✓	✓	✓
SD	Urine abnormality	·	·	✓
SD	Wheezing	✓	✓	✓
SRO	Chest pain	·	·	✓
SRO	Neck pain	·	·	✓
SRO	Pain in extremity	·	·	✓
SRO	Pain of skin	·	·	✓
SRO	Pre-existing condition improved	✓	✓	✓
SRO	Rash	·	·	✓
SRO	Spinal pain	·	·	✓
SRO	Swelling	·	·	✓

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