5LJ-31625-11371

3 vaccinations 8 coded responses 33 check-ins 8 free-text entries 3 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 762 / TX
Registered: 2021-01-04

Relationship: Self
Race: N/A
Ethnicity: N/A

Timeline

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

2021-01-04
Registered in v-safe
2021-01-04
Dose 1 — Moderna
2021-01-04
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-01-04
Report sent to call center — day 0, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-11
Health check-in — day 7, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-01-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-01
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-02
Dose 2 — Moderna
2021-02-02
Survey response — day 0, dose 2
MedDRA: Chills, Peripheral coldness, Tinnitus — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Ears ringing, shivering from pain, extremely cold with hands and feet being icy cold

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Survey response — days 1–6 daily, dose 2
MedDRA: Pain of skin, Tinnitus — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Ringing ears, ultra painful skin... hurts without being touched and wearing clothes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Survey response — days 1–6 daily, dose 2
MedDRA: Eye irritation, Heart rate increased, Ocular hyperaemia, Tinnitus — Feeling: Good · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches

Free text: Eyes super blood sho, red, and burning all day, ringing ears, elevated heart rate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Survey response — days 1–6 daily, dose 2
MedDRA: Eye pain, Eye swelling, Feeling abnormal, Flushing, Ocular discomfort, Vision blurred, Visual impairment — Feeling: Good · Site: Pain

Free text: Swelling and soreness behind and around my eyes... my field of vision is limited due to what I believe is pressure/ swelling above and behind the eyes.. Vision blurry is when I look to the sides and I feel pressure like someone is pushing on my eyeball. I have also experienced a flushing response in my face over the last few days since my second vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Eye pain, Eye swelling, Periorbital swelling, Visual field defect — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Extremely swollen and puffy eyes affecting peripheral vision and causing eye pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-09
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-23
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-02
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-03
Survey response — 6 months, dose 2
MedDRA: Myalgia, Nausea, Office visit, Pain, Pyrexia, Rales, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Covid like symptoms on July 8-12th. Fever 101.1, severe body/ muscle aches, crackle sound in lungs- clear ct scan, tho, and nausea. Neg Covid test on 12th.Based on IgM and IgG positive antibodies test for Spike protein- said Covid, tho vaccine · Healthcare visit (other): Pulmonologist

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-03
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-05
Call successful
Participant prefers to complete VAERS report online
2021-10-08
Dose 3 — Moderna
2021-10-24
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-10-29
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-05
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-12
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-07
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-08
Survey response — 6 months, dose 3
MedDRA: Nasopharyngitis — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Cold

MedDRA releases: 2024-11 · check-in free text available
2022-04-08
Report sent to call center — 6 months, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-12
Call 1 — Left Voicemail
2022-10-08
Survey response — 12 months, dose 3
MedDRA: Transient ischaemic attack — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: TIA

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-02-02	Moderna
3	2021-10-08	Moderna	No

Call center

3 call center cases

1 successful · 1 unsuccessful · 1 priority 2/3 (triaged and no follow up)

See the call center timeline

Free text

Release 3 — day 0, dose 2

2021-02-02

Systemic reaction (other): Ears ringing, shivering from pain, extremely cold with hands and feet being icy cold

Release 3 — days 1–6 daily, dose 2

2021-02-03

Systemic reaction (other): Ringing ears, ultra painful skin... hurts without being touched and wearing clothes

2021-02-04

Systemic reaction (other): Eyes super blood sho, red, and burning all day, ringing ears, elevated heart rate

2021-02-05

Systemic reaction (other): Swelling and soreness behind and around my eyes... my field of vision is limited due to what I believe is pressure/ swelling above and behind the eyes.. Vision blurry is when I look to the sides and I feel pressure like someone is pushing on my eyeball. I have also experienced a flushing response in my face over the last few days since my second vaccine.

2021-02-06

Systemic reaction (other): Extremely swollen and puffy eyes affecting peripheral vision and causing eye pain.

Release 9 — 6 months, dose 2

2021-08-03

Symptoms: Covid like symptoms on July 8-12th. Fever 101.1, severe body/ muscle aches, crackle sound in lungs- clear ct scan, tho, and nausea. Neg Covid test on 12th.Based on IgM and IgG positive antibodies test for Spike protein- said Covid, tho vaccine

Healthcare visit (other): Pulmonologist

Release 11 — 6 months, dose 3

2022-04-08

Symptoms: Cold

Release 12 — 12 months, dose 3

2022-10-08

Symptoms: TIA

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	✓	·	✓
SD	Myalgia	✓	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Nausea	✓	·	✓
SD	Pain	✓	·	✓
SD	Pyrexia	✓	·	✓
SD	Rales	✓	·	✓
SD	SARS-CoV-2 test negative	✓	·	✓
SD	Transient ischaemic attack	·	·	✓
SRO	Chills	✓	✓	✓
SRO	Eye irritation	✓	✓	✓
SRO	Eye pain	✓	✓	✓
SRO	Eye swelling	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Flushing	✓	✓	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Ocular discomfort	✓	✓	✓
SRO	Ocular hyperaemia	✓	✓	✓
SRO	Pain of skin	✓	✓	✓
SRO	Periorbital swelling	✓	✓	✓
SRO	Peripheral coldness	✓	✓	✓
SRO	Tinnitus	✓	✓	✓
SRO	Vision blurred	✓	✓	✓
SRO	Visual field defect	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

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