3ZX-71602-65389

Timeline

1. 2021-01-17
   Dose 1 — Moderna
2. 2021-02-14
   Dose 2 — Moderna
3. 2021-03-07
   Registered in v-safe
4. 2021-03-07
   Survey response — day 21, dose 2

   MedDRA: Ataxia, Cognitive disorder, Confusional state, Dizziness, Gait disturbance, Influenza like illness, Nausea, Paranoia, Thinking abnormal — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

   Free text: #2 vaccine - flu like symptoms on 2/15 & 2/16. 2/17 - nausea,neurological/psychiatric event including dizziness, extreme ataxia, paranoia, cognitive impairment & altered thinking.Intermittent sx's conti unabated. difficulty walking & confusion

   MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
5. 2021-03-14
   Survey response — day 28, dose 2

   MedDRA: Aphasia, Asthenia, Balance disorder, Blood pressure increased, Confusional state, Dizziness, Emergency care, Fatigue, Feeling abnormal, Headache, Irritability, Nausea — 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, Emergency room or emergency department visit

   Free text: Intermittent dizziness,off balance,brain fog,weakness,^BP,irritability,aphasia,nausea,headache,confusion,fatigue Intermittent episodes,lasting 4+hours ER visit 3/14/21

   MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
6. 2021-03-14
   Report sent to call center — day 28, 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)
7. 2021-03-21
   Survey response — day 35, dose 2

   MedDRA: Blood pressure increased, Gait disturbance — Feeling: Poor · 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

   Free text: Worsening problem with gait, seen by neurologist &-. MRI, EEG,EMG,B/W on order. Seen in ED for worsening sxs. Spike in BP -on med. physical therapy ordered & scheduled

   MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
8. 2021-03-21
   Report sent to call center — day 35, 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)
9. 2021-03-28
   Survey response — day 42, dose 2

   MedDRA: Balance disorder, Deafness, Dysphemia, Fatigue, Headache, Hypoaesthesia, Irritability, Muscle spasms, Nausea, Peripheral swelling, Pollakiuria, Poor quality sleep, Restlessness, Tinnitus — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

   Free text: Tinnitus swelling in feet increased neuro-poor balance H/AGait problem Falling Hearing lossNauseaUrinating frequently Poor sleep Extreme exhaustion RestlessIrritable Stuttering/diff finding wordsNumbness fingers/toesCramps

   MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
10. 2021-05-16
    Health check-in — 3 months, dose 2

    Feeling: Fair

    Adult check-in
11. 2021-08-15
    Survey response — 6 months, dose 2

    MedDRA: Brain fog, Constipation, Fatigue, Micturition urgency, Mood altered, Neuropathy peripheral, Pollakiuria, Weight decreased — Feeling: Fair · 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: Peripheral neuropathy of hands & feet. Extreme mood changes. Fatigue, weight loss, urinary frequency & urgancy Brain fog, constipation

    MedDRA releases: 2021-09,2024-11 · check-in free text available
12. 2021-08-15
    Report sent to call center — 6 months, dose 2

    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

    1 call case(s)
13. 2021-08-18
    Call 1 — Could Not Reach Participant
14. 2021-08-23
    Call 2 — Could Not Reach Participant
15. 2022-02-14
    Survey response — 12 months, dose 2

    MedDRA: Depression, Neuropathy peripheral — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

    Free text: Peripheral neuropathy of hands& feet. Depression

    MedDRA releases: 2024-11 · check-in free text available
16. 2022-02-14
    Report sent to call center — 12 months, dose 2

    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

    Hospitalization · 1 call case(s)
17. 2022-02-17
    Call successful

    Reported to VAERS voluntarily prior to GDIT contact