43C-17656-10310

2 vaccinations 6 coded responses 21 check-ins 6 free-text entries 5 call cases

Sex: Female
Age at first dose: 26-30
ZIP prefix: 851 / AZ
Registered: 2021-04-09

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

2021-04-09
Registered in v-safe
2021-04-09
Dose 1 — Moderna
2021-04-09
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-04-15
Survey response — days 1–6 daily, dose 1
MedDRA: Office visit — Feeling: Fair · Headache, Fatigue or tiredness · Get care from a doctor or other healthcare professional

Free text: In person primary care visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-16
Health check-in — day 7, dose 1
Feeling: Good · Headache

Adult check-in
2021-04-23
Survey response — day 14, dose 1
MedDRA: Dizziness, Migraine, Nausea, Office visit, Visual impairment — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Migraine, dizziness, nausea, vision changes · Healthcare visit (other): Primary care, ENT, Neurologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-02
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-07
Dose 2 — Moderna
2021-05-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Muscle or body aches, Nausea, Abdominal pain

Adult check-in
2021-05-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-05-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-14
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-28
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-04
Survey response — day 28, dose 2
MedDRA: Cough, Headache, Paranasal sinus discomfort, Sneezing — Feeling: Fair

Free text: Headache, sinus pressure, sneezing, slight cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-11
Survey response — day 35, dose 2
MedDRA: Mouth ulceration, Oral blood blister, Oral disorder — Feeling: Good · 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: Mouth covered in ulcers

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-11
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-18
Survey response — day 42, dose 2
MedDRA: Dizziness, Pre-existing disease, Thrombosis — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Very heavy periods and large clots. I have PCOS so its not uncommon but I lost so much blood very suddenly that I nearly passed out.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-18
Report sent to call center — day 42, dose 2
Be unable to work or attend school · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-18
Call 1 — Left Voicemail
2021-06-18
Call 1 — Left Voicemail
2021-06-18
Call 1 — Left Voicemail
2021-06-24
Call 2 — Left Voicemail
2021-06-24
Call 2 — Left Voicemail
2021-06-24
Call 2 — Left Voicemail
2021-06-24
Call 1 — Left Voicemail
2021-08-08
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-11-05
Survey response — 6 months, dose 2
MedDRA: Decreased appetite, Gingival ulceration, Office visit, Pain, Tongue ulceration — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I have been getting ulcers all around my tongue and gums. My doctors don't know why. They are very painful and keep me from eating sometimes. · Healthcare visit (other): PCP visit

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
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)
2021-11-10
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-09	Moderna
2	2021-05-07	Moderna

Call center

5 call center cases

5 successful

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-15

Healthcare visit (other): In person primary care visit

Release 7 — day 14, dose 1

2021-04-23

Symptoms: Migraine, dizziness, nausea, vision changes

Healthcare visit (other): Primary care, ENT, Neurologist

Release 8 — day 28, dose 2

2021-06-04

Symptoms: Headache, sinus pressure, sneezing, slight cough

Release 9 — day 35, dose 2

2021-06-11

Symptoms: Mouth covered in ulcers

Release 9 — day 42, dose 2

2021-06-18

Symptoms: Very heavy periods and large clots. I have PCOS so its not uncommon but I lost so much blood very suddenly that I nearly passed out.

Release 10 — 6 months, dose 2

2021-11-05

Symptoms: I have been getting ulcers all around my tongue and gums. My doctors don't know why. They are very painful and keep me from eating sometimes.

Healthcare visit (other): PCP visit

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	Cough	✓	✓	✓
SD	Decreased appetite	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Gingival ulceration	·	·	✓
SD	Headache	✓	✓	✓
SD	Migraine	✓	✓	✓
SD	Mouth ulceration	·	·	✓
SD	Nausea	✓	✓	✓
SD	Office visit	·	·	✓
SD	Oral blood blister	✓	✓	○
SD	Oral disorder	✓	✓	○
SD	Pain	·	·	✓
SD	Paranasal sinus discomfort	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Sneezing	✓	✓	✓
SD	Thrombosis	✓	✓	✓
SD	Tongue ulceration	·	·	✓
SD	Visual impairment	✓	✓	✓

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