3YV-16775-27766

2 vaccinations 13 coded responses 24 check-ins 13 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 600 / IL
Registered: 2021-03-17

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

2021-03-17
Registered in v-safe
2021-03-17
Dose 1 — Moderna
2021-03-17
Survey response — day 0, dose 1
MedDRA: Dizziness, Ear discomfort, Feeling abnormal — Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Dizzy & pressure in ears & foggy headed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Balance disorder, Cognitive disorder, Dizziness, Feeling abnormal — Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Dizzy, fuzzy headed, cognitive impairment, balance

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — days 1–6 daily, dose 1
MedDRA: Balance disorder, Cognitive disorder, Disorientation, Disturbance in attention — Feeling: Fair · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Cognitive impairment, disoriented, unable to focus, making mistakes, balance off

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — days 1–6 daily, dose 1
MedDRA: Cognitive disorder, Nausea — Feeling: Good · Headache

Free text: Slight cognitive impairment, slight nausea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Nausea

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-27
Survey response — day 7, dose 1
MedDRA: Balance disorder, Cognitive disorder, Ear discomfort, Head discomfort — Feeling: Poor · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Balance, forehead and ear pressure, cognitive impairmant

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-04-07
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-04-14
Dose 2 — Moderna
2021-04-15
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Balance disorder, Dizziness, Paraesthesia, Peripheral swelling, Swelling face — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Dizziness, balance issues, tingling hands and feet and face, deep lower back pain, feeling swollen like water retention all over especially hands and feet and face, wearing down coat w good inside all day w temp at 74,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Headache, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: If Moderna makes the booster combined with flu vaccine I wont be taking it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Cognitive disorder, Dizziness, Insomnia — Feeling: Fair · Fever · Headache, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Still dizzy, balance issues, cognitive impairment. Insomnia now for 3 nights.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Cognitive disorder, Dizziness, Ear discomfort, Headache, Medical counselling — Feeling: Poor · Fever · Headache, Nausea · 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: Systemic reaction (other): Migrating headache, intermittent ear pressure, intermittent dizziness & imbalance, intermittent cognitive impairment · Healthcare visit (other): Called my PCP

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Report sent to call center — days 1–6 daily, 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)
2021-04-20
Survey response — days 1–6 daily, dose 2
MedDRA: Cognitive disorder, Dizziness, Inflammation — Feeling: Poor · Headache, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Brain inflammation dizziness cognitive impairment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Survey response — day 7, dose 2
MedDRA: Balance disorder, Feeling abnormal, Hyperhidrosis, Tremor — Feeling: Poor · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Sweating, fuzzy headed, shaky, off balance

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-19
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-05-26
Survey response — day 42, dose 2
MedDRA: Feeling abnormal, Headache — Feeling: Fair

Free text: Floating headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-14
Survey response — 3 months, dose 2
MedDRA: Blood pressure decreased, Office visit, Presyncope, Retinal haemorrhage — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Since my vaccine I have been having intermittent huge bp drops where I almost faint. I was just diagnosed w flame heme in my right retina w no underlying conditions except vaccine. · Healthcare visit (other): Optometrist visit for discovery. Follow up w Retina care specialist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-14
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-22
Call successful
Does not wish to fill out VAERS report
2021-10-13
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-04-17
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-17	Moderna
2	2021-04-14	Moderna

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 5 — day 0, dose 1

2021-03-17

Systemic reaction (other): Dizzy & pressure in ears & foggy headed

Release 5 — days 1–6 daily, dose 1

2021-03-18

Systemic reaction (other): Dizzy, fuzzy headed, cognitive impairment, balance

2021-03-19

Systemic reaction (other): Cognitive impairment, disoriented, unable to focus, making mistakes, balance off

Release 6 — days 1–6 daily, dose 1

2021-03-20

Systemic reaction (other): Slight cognitive impairment, slight nausea

Release 6 — day 7, dose 1

2021-03-27

Systemic reaction (other): Balance, forehead and ear pressure, cognitive impairmant

Release 7 — days 1–6 daily, dose 2

2021-04-15

Systemic reaction (other): Dizziness, balance issues, tingling hands and feet and face, deep lower back pain, feeling swollen like water retention all over especially hands and feet and face, wearing down coat w good inside all day w temp at 74,

2021-04-16

Systemic reaction (other): If Moderna makes the booster combined with flu vaccine I wont be taking it.

2021-04-17

Systemic reaction (other): Still dizzy, balance issues, cognitive impairment. Insomnia now for 3 nights.

2021-04-19

Systemic reaction (other): Migrating headache, intermittent ear pressure, intermittent dizziness & imbalance, intermittent cognitive impairment

Healthcare visit (other): Called my PCP

2021-04-20

Systemic reaction (other): Brain inflammation dizziness cognitive impairment

Release 7 — day 7, dose 2

2021-04-23

Systemic reaction (other): Sweating, fuzzy headed, shaky, off balance

Release 8 — day 42, dose 2

2021-05-26

Symptoms: Floating headache

Release 9 — 3 months, dose 2

2021-07-14

Symptoms: Since my vaccine I have been having intermittent huge bp drops where I almost faint. I was just diagnosed w flame heme in my right retina w no underlying conditions except vaccine.

Healthcare visit (other): Optometrist visit for discovery. Follow up w Retina care specialist

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	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Blood pressure decreased	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Presyncope	✓	✓	✓
SD	Retinal haemorrhage	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Balance disorder	✓	✓	✓
SRO	Cognitive disorder	✓	✓	✓
SRO	Disorientation	✓	✓	✓
SRO	Disturbance in attention	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Ear discomfort	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Head discomfort	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Inflammation	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓
SRO	Swelling face	✓	✓	✓
SRO	Tremor	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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