4CJ-99492-12588
2 vaccinations
3 coded responses
24 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 626 / IL
- Registered
- 2020-12-31
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-31
Registered in v-safe
-
2020-12-31
Dose 1 — Moderna
- 2020-12-31
-
2021-01-01
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2021-01-02
- 2021-01-03
- 2021-01-04
- 2021-01-06
- 2021-01-07
- 2021-01-14
- 2021-01-21
-
2021-01-27
Dose 2 — Moderna
-
2021-01-28
Survey response — days 1–6 daily, dose 2MedDRA: Unevaluable event — Feeling: Good · Site: Pain · Fatigue or tirednessFree text: Symptoms day of shot 1/27MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-29
- 2021-01-30
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-10
- 2021-02-17
- 2021-02-24
- 2021-03-03
- 2021-03-10
-
2021-04-28
Survey response — 3 months, dose 2MedDRA: Blindness unilateral, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Symptoms: Loss of visual field in left eye. Have had some bilateral loss 25 years ago. Began mid March. No diagnosis at the moment leaning towards NAION · Healthcare visit (other): Seeing specialistMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-28
Report sent to call center — 3 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-07-28
Survey response — 6 months, dose 2MedDRA: Blindness unilateral, Condition aggravated, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activitiesFree text: Optic neuritis left eye 3/11 symptoms. Loss of vision . Have history but have not had any attacks for 20 years prior to the vaccine. No other symptoms prior to attack. Residual vision loss has occurred in left eye. No diagnosis except auto immune knMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-12-30
Call successfulParticipant prefers to complete VAERS report online
- 2022-01-28
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-31 | Moderna | |
| 2 | 2021-01-27 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 3 — days 1–6 daily, dose 2
Systemic reaction (other): Symptoms day of shot 1/27
Release 8 — 3 months, dose 2
Symptoms: Loss of visual field in left eye. Have had some bilateral loss 25 years ago. Began mid March. No diagnosis at the moment leaning towards NAION
Healthcare visit (other): Seeing specialist
Release 9 — 6 months, dose 2
Symptoms: Optic neuritis left eye 3/11 symptoms. Loss of vision . Have history but have not had any attacks for 20 years prior to the vaccine. No other symptoms prior to attack. Residual vision loss has occurred in left eye. No diagnosis except auto immune kn cut off by CDC
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 | Unevaluable event | ✓ | ✓ | ✓ |
| SD | Blindness unilateral | ✓ | ✓ | ✓ |
| SD | Condition aggravated | ✓ | · | ✓ |
| SD | Pre-existing disease | ✓ | · | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release