4GV-40831-23796

2 vaccinations 9 coded responses 15 check-ins 9 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 981 / WA
Registered: 2021-06-01

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

2020-12-29
Call 2 — Could Not Reach Participant
2021-05-28
Dose 1 — Moderna
2021-06-01
Registered in v-safe
2021-06-01
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Hypoaesthesia, Paraesthesia — Feeling: Good · Nausea

Free text: Dizzy + hands tingled a bit and were slightly numb (had severe reaction to wasp bite many years ago - carry epi pen now) also have other conditions. )

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Survey response — days 1–6 daily, dose 1
MedDRA: Peripheral swelling — Feeling: Fair

Free text: Some feet swelling due to heat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-03
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Gait disturbance, Musculoskeletal stiffness — Feeling: Fair · Headache, Muscle or body aches, Nausea

Free text: Difficulty walking (stiff), whoozy at times -- different than heat related

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Health check-in — day 7, dose 1
Feeling: Fair · Muscle or body aches

Adult check-in
2021-06-13
Survey response — day 14, dose 1
MedDRA: Dizziness — Feeling: Fair

Free text: Somewhat woozy more often...but I function through it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-18
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-06-26
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-06-29
Dose 2 — Moderna
2021-07-09
Survey response — day 7, dose 2
MedDRA: Dizziness — Feeling: Fair

Free text: Wooziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-13
Survey response — day 14, dose 2
MedDRA: Dizziness — Feeling: Fair

Free text: Whooziness more frequently...

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-20
Survey response — day 21, dose 2
MedDRA: Condition aggravated, Hypertension, Pre-existing disease — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Problem with ileostomy and hernia...+ very high bp

MedDRA releases: 2024-11 · check-in free text available
2021-07-20
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-27
Call 2 — Left Voicemail
2021-07-30
Call successful
Participant prefers to complete VAERS report online
2021-08-03
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-08-10
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-09-30
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-12-28
Survey response — 6 months, dose 2
MedDRA: Breast cancer, Palpitations — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Ocassiobal palpitations + diagnosis of breast cancer...+other

MedDRA releases: 2024-11 · check-in free text available
2021-12-28
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
2021-12-30
Call 3 — Left Voicemail
2022-07-03
Survey response — 12 months, dose 2
MedDRA: Breast conserving surgery, Breast cyst, Mastitis, Surgery — 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, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Non-covid. Severe breast cyst infection + lumpectomy. · Healthcare visit (other): Surgery

MedDRA releases: 2024-11 · check-in free text available
2022-07-03
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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-07-05
Call 1 — Requested Callback
2022-07-05
Call 1 — Requested Callback
2022-07-05
Call 1 — Requested Callback
2022-07-05
Callback requested for
06:00PM ET
2022-07-05
Call successful
Participant prefers to complete VAERS report online
2022-07-05
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-28	Moderna
2	2021-06-29	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 8 — days 1–6 daily, dose 1

2021-06-01

Systemic reaction (other): Dizzy + hands tingled a bit and were slightly numb (had severe reaction to wasp bite many years ago - carry epi pen now) also have other conditions. )

2021-06-02

Systemic reaction (other): Some feet swelling due to heat

2021-06-03

Systemic reaction (other): Difficulty walking (stiff), whoozy at times -- different than heat related

Release 9 — day 14, dose 1

2021-06-13

Symptoms: Somewhat woozy more often...but I function through it.

Release 9 — day 7, dose 2

2021-07-09

Systemic reaction (other): Wooziness

Release 9 — day 14, dose 2

2021-07-13

Symptoms: Whooziness more frequently...

Release 9 — day 21, dose 2

2021-07-20

Symptoms: Problem with ileostomy and hernia...+ very high bp

Release 10 — 6 months, dose 2

2021-12-28

Symptoms: Ocassiobal palpitations + diagnosis of breast cancer...+other

Release 12 — 12 months, dose 2

2022-07-03

Symptoms: Non-covid. Severe breast cyst infection + lumpectomy.

Healthcare visit (other): Surgery

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	Surgery	·	·	✓
SD	Breast cancer	·	·	✓
SD	Breast conserving surgery	·	·	✓
SD	Breast cyst	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Hypertension	·	·	✓
SD	Mastitis	·	·	✓
SD	Palpitations	·	·	✓
SD	Pre-existing disease	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Gait disturbance	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Musculoskeletal stiffness	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓

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