432-11796-92156
1 vaccination
5 coded responses
9 check-ins
5 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 954 / CA
- Registered
- 2021-02-08
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-08
Registered in v-safe
-
2021-02-08
Dose 1 — Moderna
- 2021-02-08
-
2021-02-09
Survey response — days 1–6 daily, dose 1MedDRA: Lymphadenopathy, Swelling — Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tirednessFree text: Swollen lymph nodes in neckMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-10
- 2021-02-11
-
2021-02-12
Survey response — days 1–6 daily, dose 1MedDRA: Condition aggravated, Pre-existing disease — Feeling: GoodFree text: Soft tissue pain on R front calf from years ago (which had gone quiescent) ramped up again the day after injection. Still painful & swollen)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-17
-
2021-05-10
Survey response — 3 months, dose 1MedDRA: Eye pain, Facial pain, Office visit — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Pain around R eye and on R cheek. · Healthcare visit (other): In person appointments with opthamologist, dentist, endodontistMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-10
Report sent to call center — 3 months, dose 1Get care from a doctor or other healthcare professional1 call case(s)
-
2021-08-09
Survey response — 6 months, dose 1MedDRA: Dyspnoea, Emergency care — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Trouble breathing. Went to ER.MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-09
Report sent to call center — 6 months, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-12
-
2022-02-08
Survey response — 12 months, dose 1MedDRA: Asthenia, Endovenous ablation, Office visit, Peripheral venous disease, Phlebitis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Venous insufficiency. RF ablation of great saphonous veins in each leg. Debilitating painful, on-going phlebitis ever since. · Healthcare visit (other): In person office visits & lots of scansMedDRA releases: 2024-11 · check-in free text available
-
2022-02-08
Report sent to call center — 12 months, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2022-02-10
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-08 | Moderna |
Call center
3 call center cases
1 successful · 2 unsuccessful
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): Swollen lymph nodes in neck
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Soft tissue pain on R front calf from years ago (which had gone quiescent) ramped up again the day after injection. Still painful & swollen)
Release 8 — 3 months, dose 1
Symptoms: Pain around R eye and on R cheek.
Healthcare visit (other): In person appointments with opthamologist, dentist, endodontist
Release 9 — 6 months, dose 1
Symptoms: Trouble breathing. Went to ER.
Release 11 — 12 months, dose 1
Symptoms: Venous insufficiency. RF ablation of great saphonous veins in each leg. Debilitating painful, on-going phlebitis ever since.
Healthcare visit (other): In person office visits & lots of scans
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 | Asthenia | · | · | ✓ |
| SD | Dyspnoea | ✓ | · | ✓ |
| SD | Emergency care | ✓ | · | ✓ |
| SD | Endovenous ablation | · | · | ✓ |
| SD | Eye pain | ✓ | ✓ | ✓ |
| SD | Facial pain | ✓ | ✓ | ✓ |
| SD | Peripheral venous disease | · | · | ✓ |
| SD | Phlebitis | · | · | ✓ |
| SRO | Condition aggravated | ✓ | ✓ | ✓ |
| SRO | Lymphadenopathy | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Swelling | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release