4XM-37019-30997

3 vaccinations 8 coded responses 10 check-ins 8 free-text entries 8 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 956 / CA
Registered: 2021-03-19

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

2021-02-12
Dose 1 — Moderna
2021-03-18
Dose 2 — Moderna
2021-03-19
Registered in v-safe
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · None

Adult check-in
2021-03-23
Survey response — days 1–6 daily, dose 2
MedDRA: Blindness, Blindness unilateral, Unevaluable event — Feeling: Poor · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Systemic reaction (other): Left eye vision loss · Healthcare visit (other): See previous submissuon

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-24
Survey response — days 1–6 daily, dose 2
MedDRA: Blindness, Blindness unilateral — Feeling: Poor · Chills, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Systemic reaction (other): Left eye half blind · Healthcare visit (other): Eye sight liss

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-27
Health check-in — day 7, dose 2
Feeling: Poor · Site: Swelling · Headache, Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2021-04-01
Survey response — day 14, dose 2
MedDRA: Blindness — 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, Hospitalization

Free text: Loss of eyesight

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-08
Survey response — day 21, dose 2
MedDRA: Blindness unilateral, Visual impairment — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Eyesight is getting worse. Left eye is half blind.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
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)
2021-04-19
Survey response — day 28, dose 2
MedDRA: Blindness, Giant cell arteritis, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: I have been diagnosed with Giant Cell Arteritis, with 50% sight loss in left eye and partial in right eye.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-28
Survey response — day 35, dose 2
MedDRA: Giant cell arteritis, Pre-existing disease, Unevaluable event — 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, Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: I had Verified Diagnosis for Polymyalgia Rheumatica , (positive for both left and right temporal arteries) then two weeks after first Moderna Vaccine I was verified to have Giant Cell Arteritis, and am scheduled for the next year to be in Cortisone. · Healthcare visit (other): You. Name the test, I probably had them.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-09
Call 1 — Left Voicemail
2021-06-19
Survey response — 3 months, dose 2
MedDRA: Giant cell arteritis, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: I dont remember what info I gave you so Im going to recap from the beginning. I had a first moderne shot Feb 12.. within a week I contracted Giant Cell Arteritis. Although they hadnt named it yet. I was hospitalized 3 nites 4 days in (b)(6) Az · Healthcare visit (other): I had N outside ophthalmologist involved in my care. I wasnt officially diagnosed until mid Mar. although I had diagnosed myself about ?4-5 weeks prior to the official. A result of my own research an use of common sense symptoms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-19
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-29
Call 1 — Left Voicemail
2021-07-15
Call 2 — Requested Callback
2021-07-19
Call 3 — Requested Callback
2021-07-19
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2021-09-07
Dose 3 — Moderna
2022-03-08
Survey response — 6 months, dose 3
MedDRA: Office visit, Pre-existing disease — 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, Hospitalization

Free text: Symptoms: Did I ever mention I came down with giant cell arteritis about a year ago? · Healthcare visit (other): Treated by a rheumatologist

MedDRA releases: 2024-11 · check-in free text available
2022-03-08
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-03-09
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-12	Moderna
2	2021-03-18	Moderna
3	2021-09-07	Moderna	No

Call center

8 call center cases

2 successful · 6 unsuccessful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-23

Systemic reaction (other): Left eye vision loss

Healthcare visit (other): See previous submissuon

2021-03-24

Systemic reaction (other): Left eye half blind

Healthcare visit (other): Eye sight liss

Release 6 — day 14, dose 2

2021-04-01

Symptoms: Loss of eyesight

Release 7 — day 21, dose 2

2021-04-08

Symptoms: Eyesight is getting worse. Left eye is half blind.

Release 7 — day 28, dose 2

2021-04-19

Symptoms: I have been diagnosed with Giant Cell Arteritis, with 50% sight loss in left eye and partial in right eye.

Release 8 — day 35, dose 2

2021-04-28

Symptoms: I had Verified Diagnosis for Polymyalgia Rheumatica , (positive for both left and right temporal arteries) then two weeks after first Moderna Vaccine I was verified to have Giant Cell Arteritis, and am scheduled for the next year to be in Cortisone. cut off by CDC

Healthcare visit (other): You. Name the test, I probably had them.

Release 9 — 3 months, dose 2

2021-06-19

Symptoms: I dont remember what info I gave you so Im going to recap from the beginning. I had a first moderne shot Feb 12.. within a week I contracted Giant Cell Arteritis. Although they hadnt named it yet. I was hospitalized 3 nites 4 days in (b)(6) Az

Healthcare visit (other): I had N outside ophthalmologist involved in my care. I wasnt officially diagnosed until mid Mar. although I had diagnosed myself about ?4-5 weeks prior to the official. A result of my own research an use of common sense symptoms.

redacted (b)(6)

Release 11 — 6 months, dose 3

2022-03-08

Symptoms: Did I ever mention I came down with giant cell arteritis about a year ago?

Healthcare visit (other): Treated by a rheumatologist

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	Blindness	✓	✓	✓
HCVO	Office visit	·	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Blindness	✓	✓	✓
SD	Blindness unilateral	○	✓	○
SD	Giant cell arteritis	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Visual impairment	✓	✓	✓
SRO	Blindness	○	✓	○
SRO	Blindness unilateral	✓	✓	✓

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