4FR-13502-17902 · OpenVSafe

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-17
Dose 1 — Moderna
2021-05-15
Dose 2 — Moderna
2021-05-17
Registered in v-safe
2021-05-17
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-18
Survey response — days 1–6 daily, dose 2
MedDRA: Blood disorder, Pre-existing disease — Feeling: Poor · Site: Pain, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: I have granulomatosis with polyangiitis ( GPA) and wanted someone to understand that anything that effects the auto immune system , like me , can get a illness flare , while in and of itself we deal with , another adverse effect is that granulomatosis with polyangiitis ( GPA) has caused me to be legally blind and every flair makes my eyesight worse never to come back , the pain is all over , I call is my I sing my body electric I feel my veins are stressed ...

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Survey response — days 1–6 daily, dose 2
MedDRA: Condition aggravated, Dizziness, Epistaxis, Pre-existing disease — Feeling: Fair · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizziness and bloody nose both being part of a granulomatosis with polyangiitis ( GPA) flair which was infused by the vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Survey response — days 1–6 daily, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Free text: This is a granulomatosis with polyangiitis ( GPA) flair brought on my the vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-22
Health check-in — day 7, dose 2
Feeling: Fair · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-29
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-07
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-28
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-11-14
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-17	Moderna
2	2021-05-15	Moderna

Free text

Release 8 — days 1–6 daily, dose 2

2021-05-18

Systemic reaction (other): I have granulomatosis with polyangiitis ( GPA) and wanted someone to understand that anything that effects the auto immune system , like me , can get a illness flare , while in and of itself we deal with , another adverse effect is that granulomatosis with polyangiitis ( GPA) has caused me to be legally blind and every flair makes my eyesight worse never to come back , the pain is all over , I call is my I sing my body electric I feel my veins are stressed ...

2021-05-19

Systemic reaction (other): Dizziness and bloody nose both being part of a granulomatosis with polyangiitis ( GPA) flair which was infused by the vaccine

2021-05-20

Systemic reaction (other): This is a granulomatosis with polyangiitis ( GPA) flair brought on my the vaccine

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
SRO	Blood disorder	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Epistaxis	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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