4UQ-10539-96502

2 vaccinations 8 coded responses 21 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 803 / CO
Registered: 2021-01-07

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

2021-01-07
Registered in v-safe
2021-01-07
Dose 1 — Moderna
2021-01-07
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-09
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Fair · Fatigue or tiredness

Free text: Rt arm is still sore, but not as much

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Survey response — day 14, dose 1
MedDRA: Injection site pruritus, Pruritus, Rash erythematous — Feeling: Fair

Free text: A 3 red rash that itches some at the injection site and some upper body itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — day 21, dose 1
MedDRA: Rash erythematous, Rash pruritic — Feeling: Good

Free text: Itching red rash across by upper back yesterday. My Dr. gave me Triamcinolone Acetonide 0.1% cream and redness and bumps are gone and itching decreased. Probably nothing to do with the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Dose 2 — Moderna
2021-02-04
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness · 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
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Itching · Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · Fatigue or tiredness, Diarrhea · Be unable to work

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 2
MedDRA: Vision blurred — Feeling: Good · Site: Pain, Redness, Itching · Joint pains

Free text: My vision has become blurry - seeing Ophthamologist next week

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — days 1–6 daily, dose 2
MedDRA: Vision blurred — Feeling: Good · Site: Itching · Headache, Fatigue or tiredness, Abdominal pain

Free text: Vision still blurry, getting new vision tests tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Health check-in — day 7, dose 2
Feeling: Good · Site: Redness, Itching · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-18
Survey response — day 14, dose 2
MedDRA: Colitis, Diarrhoea — Feeling: Poor · Be unable to work, 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: My descending colon has become very inflamed and severe diarrhea. Having a C scan tomorrow. Have a history of colon issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Report sent to call center — day 14, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-25
Survey response — day 21, dose 2
MedDRA: Colitis, Muscle spasms, Vision blurred — 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

Free text: I have had a major colon inflammation and cramping. My GI doc ordered a CT scan which showed no problems. Waiting for bacteria panel. Dont know if related to vaccine, but feel my autoimmune system is running in high gear. Also have blurred vision.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-06
Survey response — 3 months, dose 2
MedDRA: Visual impairment — Feeling: Good

Free text: My vision changed dramatically between the 2 shots. Got much worse. Dont know if it is related to the vaccine. Want to report it incase there is a pattern.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-05
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-08-10
Call successful
Participant prefers to complete VAERS report online
2022-02-04
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-07	Moderna
2	2021-02-04	Moderna

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-09

Systemic reaction (other): Rt arm is still sore, but not as much

Release 2 — day 14, dose 1

2021-01-21

Symptoms: A 3 red rash that itches some at the injection site and some upper body itching

Release 2 — day 21, dose 1

2021-01-28

Symptoms: Itching red rash across by upper back yesterday. My Dr. gave me Triamcinolone Acetonide 0.1% cream and redness and bumps are gone and itching decreased. Probably nothing to do with the vaccine.

Release 3 — days 1–6 daily, dose 2

2021-02-09

Systemic reaction (other): My vision has become blurry - seeing Ophthamologist next week

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): Vision still blurry, getting new vision tests tomorrow

Release 4 — day 14, dose 2

2021-02-18

Symptoms: My descending colon has become very inflamed and severe diarrhea. Having a C scan tomorrow. Have a history of colon issues

Release 4 — day 21, dose 2

2021-02-25

Symptoms: I have had a major colon inflammation and cramping. My GI doc ordered a CT scan which showed no problems. Waiting for bacteria panel. Dont know if related to vaccine, but feel my autoimmune system is running in high gear. Also have blurred vision.

Release 8 — 3 months, dose 2

2021-05-06

Symptoms: My vision changed dramatically between the 2 shots. Got much worse. Dont know if it is related to the vaccine. Want to report it incase there is a pattern.

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
SD	Colitis	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Muscle spasms	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Rash erythematous	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SD	Vision blurred	✓	✓	✓
SD	Visual impairment	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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