53P-17940-09628

2 vaccinations 11 coded responses 18 check-ins 11 free-text entries 4 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 967 / HI
Registered: 2021-04-06

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

2021-04-06
Registered in v-safe
2021-04-06
Dose 1 — Moderna
2021-04-13
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · Joint pains, Fatigue or tiredness

Adult check-in
2021-04-20
Survey response — day 14, dose 1
MedDRA: Fatigue, Nausea — Feeling: Good · Be unable to do your normal daily activities

Free text: I was really tired 2 days ago, and had a bad headache yesterday, with nausea and fatigue. I was mostly OK until 3pm, but spent the rest of the afternoon and evening in a dark room and went to bed early and slept late today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Survey response — day 21, dose 1
MedDRA: Anxiety, Gait disturbance, Hypoaesthesia, SARS-CoV-2 test negative, SARS-CoV-2 test positive — Feeling: Poor · Be unable to work, 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: Numbness of right side and face and toes on both side, troubles walking due to numb toes. Excessive anxiety over numbness getting worse every day since Friday.I had a positive Covid test but the re-test was negative.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Report sent to call center — day 21, dose 1
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)
2021-05-04
Survey response — day 28, dose 1
MedDRA: Hypoaesthesia, Office visit, Pain, Telemedicine — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: More numbness in more places. Tips of fingers and toes and face are worst, today is the first time I noticed it near my waist, and on the lower back, my behind and right side below the ribs. Also occasionally shooting pain. · Healthcare visit (other): Saw primary care physician, and telehealth appointment with allergist, will see neurologist tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Report sent to call center — day 28, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-12
Survey response — day 35, dose 1
MedDRA: Asthenia, Dizziness, Dyspnoea, Hypoaesthesia — 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, Emergency room or emergency department visit, Hospitalization

Free text: Numbness, dizzy ness, shortness of breath, weakness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Report sent to call center — day 35, dose 1
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)
2021-05-17
Dose 2 — Moderna
2021-05-18
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-19
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea, Hypoaesthesia — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Still numbness in face fingers and toes, shortness of breath

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: Hypoaesthesia — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Numbness

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

Free text: Numbness in face fingers and toes, some on arms, legs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-22
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Headache

Free text: Same

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Survey response — days 1–6 daily, dose 2
MedDRA: Hypoaesthesia — Feeling: Good · Fatigue or tiredness

Free text: Numbness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-24
Survey response — day 7, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Fatigue or tiredness

Free text: Same

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-31
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
2021-06-14
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-08-16
Survey response — 3 months, dose 2
MedDRA: Anaphylactic reaction — Feeling: Fair · 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

Free text: Anaphylaxis

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-16
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-19
Call successful
Participant prefers to complete VAERS report online
2021-11-21
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-05-19
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-06	Moderna
2	2021-05-17	Moderna

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 7 — day 14, dose 1

2021-04-20

Symptoms: I was really tired 2 days ago, and had a bad headache yesterday, with nausea and fatigue. I was mostly OK until 3pm, but spent the rest of the afternoon and evening in a dark room and went to bed early and slept late today.

Release 8 — day 21, dose 1

2021-04-27

Symptoms: Numbness of right side and face and toes on both side, troubles walking due to numb toes. Excessive anxiety over numbness getting worse every day since Friday.I had a positive Covid test but the re-test was negative.

Release 8 — day 28, dose 1

2021-05-04

Symptoms: More numbness in more places. Tips of fingers and toes and face are worst, today is the first time I noticed it near my waist, and on the lower back, my behind and right side below the ribs. Also occasionally shooting pain.

Healthcare visit (other): Saw primary care physician, and telehealth appointment with allergist, will see neurologist tomorrow

Release 8 — day 35, dose 1

2021-05-12

Symptoms: Numbness, dizzy ness, shortness of breath, weakness

Release 8 — days 1–6 daily, dose 2

2021-05-19

Systemic reaction (other): Still numbness in face fingers and toes, shortness of breath

2021-05-20

Systemic reaction (other): Numbness

2021-05-21

Systemic reaction (other): Numbness in face fingers and toes, some on arms, legs

2021-05-22

Systemic reaction (other): Same

2021-05-23

Systemic reaction (other): Numbness

Release 8 — day 7, dose 2

2021-05-24

Systemic reaction (other): Same

Release 9 — 3 months, dose 2

2021-08-16

Symptoms: Anaphylaxis

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	Office visit	✓	✓	✓
HCVO	Telemedicine	✓	✓	✓
SD	Anaphylactic reaction	✓	·	✓
SD	Anxiety	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gait disturbance	✓	✓	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pain	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	SARS-CoV-2 test positive	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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