5NP-30081-37617
4 vaccinations
11 coded responses
39 check-ins
11 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 775 / TX
- Registered
- 2021-01-15
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-01-15
Registered in v-safe
-
2021-01-15
Dose 1 — Moderna
- 2021-01-15
- 2021-01-16
- 2021-01-17
- 2021-01-18
- 2021-01-19
- 2021-01-22
- 2021-01-29
-
2021-02-05
Survey response — day 21, dose 1MedDRA: Emergency care, Heart rate increased, Hypertension, Palpitations — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Heart palpitations, high BP and pulse, had to go to the ER.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-05
Report sent to call center — day 21, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-02-12
Dose 2 — Moderna
-
2021-02-12
Survey response — day 0, dose 2MedDRA: Syringe issue — Feeling: GoodFree text: The vaccine syringe malfunctioned and syringe content spattered onto my hand. I was offered a gauze pad to dry it. I stated concern about how much (if any) vaccine got actually inoculated and staff told me not to worry and declined to inject me with part of another dose. They said that I had 80% protection with the first dose and I should be OK. I am not sure I am protected. What can I do? What can you do to @help?MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-13
-
2021-02-14
Survey response — days 1–6 daily, dose 2MedDRA: Unevaluable event — Feeling: GoodFree text: The vaccine leaked so I will need another shot. How do I get it?MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-15
Survey response — days 1–6 daily, dose 2MedDRA: Vaccination error — Feeling: GoodFree text: There was a vaccine administration error/leakage so I am in need of a repeat shot for my 2nd dose of Moderna. So far unable to make it happen!MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-16
Survey response — days 1–6 daily, dose 2MedDRA: Unevaluable event — Feeling: GoodFree text: In need of a repeat second dose of Moderna as the syringe malfunctioned. Nightmarish to try and get it!MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-17
Survey response — days 1–6 daily, dose 2MedDRA: Syringe issue — Feeling: GoodFree text: Syringe malfunctioned on 2nd shot. Need a replacement shot ASAP!MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-18
Survey response — days 1–6 daily, dose 2MedDRA: Syringe issue — Feeling: GoodFree text: Syringe for Moderna 2nd shot malfunctioned and I NEED to get a replacement shot ASAP.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-19
Survey response — day 7, dose 2MedDRA: Unevaluable event — Feeling: GoodFree text: 2nd shot syringe malfunctioned and I am in need of a replacement shot ASAP!!!MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-26
- 2021-03-05
- 2021-03-12
- 2021-03-21
- 2021-03-26
- 2021-05-14
- 2021-07-02
- 2021-08-13
-
2021-10-25
Dose 3 — Moderna
-
2022-02-13
Survey response — 12 months, dose 2MedDRA: Coating in mouth, Gingival discomfort, Office visit, Oral pain — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Received the Moderna booster on 10/25/21. A couple of days later I started experiencing burning gingiva, white spots inside the mouth, and the inside of my mouth, specially the palate, were extremely sensitive. · Healthcare visit (other): Dentist and PCPMedDRA releases: 2024-11 · check-in free text available
-
2022-02-13
Report sent to call center — 12 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2022-02-16
- 2022-02-23
-
2022-02-23
Call successfulDoes not wish to fill out VAERS report
-
2022-05-31
Dose 4 — Pfizer-BioNTech
-
2022-06-01
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-06-02
- 2022-06-03
- 2022-06-04
- 2022-06-05
- 2022-06-06
- 2022-06-07
- 2022-06-14
- 2022-06-21
- 2022-06-28
-
2022-07-05
Survey response — day 35, dose 4MedDRA: Oral disorder, Pruritus, Rash vesicular — Feeling: FairFree text: Since 6/20 I started having a mild shingles-like rash. As this happened after the 2nd booster and I also had a HZV Luke reaction in my mouth after the 1st booster, there may be a link here. Cortisone cream helps with rash/ itch. Seeking med care.MedDRA releases: 2024-11 · check-in free text available
- 2022-07-12
- 2022-08-30
-
2022-11-29
Survey response — 6 months, dose 4MedDRA: Emergency care, Macular oedema, Office visit, Retinal haemorrhage, Retinal vein occlusion, Visual impairment, Vitreous detachment — Feeling: Poor · Get care from a doctor or other healthcare professionalFree text: Symptoms: The vision in my left eye deteriorated. There was retinal bleeding and then CRVO with macular edema, treated with Avastin. On 11/17 I suffered a total posterior posterior vitreous detachment. · Healthcare visit (other): Doctor visit, specialist, ER and a second retina specialist.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-29
Report sent to call center — 6 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
- 2022-11-30
-
2022-11-30
Call successfulParticipant prefers to complete VAERS report online
- 2023-05-31
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-15 | Moderna | |
| 2 | 2021-02-12 | Moderna | |
| 3 | 2021-10-25 | Moderna | No |
| 4 | 2022-05-31 | Pfizer-BioNTech | No |
Call center
3 call center cases
3 successful
1 wait over 3 months for a first call
Free text
Release 3 — day 21, dose 1
Symptoms: Heart palpitations, high BP and pulse, had to go to the ER.
Release 4 — day 0, dose 2
Systemic reaction (other): The vaccine syringe malfunctioned and syringe content spattered onto my hand. I was offered a gauze pad to dry it. I stated concern about how much (if any) vaccine got actually inoculated and staff told me not to worry and declined to inject me with part of another dose. They said that I had 80% protection with the first dose and I should be OK. I am not sure I am protected. What can I do? What can you do to @help?
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): The vaccine leaked so I will need another shot. How do I get it?
Systemic reaction (other): There was a vaccine administration error/leakage so I am in need of a repeat shot for my 2nd dose of Moderna. So far unable to make it happen!
Systemic reaction (other): In need of a repeat second dose of Moderna as the syringe malfunctioned. Nightmarish to try and get it!
Systemic reaction (other): Syringe malfunctioned on 2nd shot. Need a replacement shot ASAP!
Systemic reaction (other): Syringe for Moderna 2nd shot malfunctioned and I NEED to get a replacement shot ASAP.
Release 4 — day 7, dose 2
Systemic reaction (other): 2nd shot syringe malfunctioned and I am in need of a replacement shot ASAP!!!
Release 11 — 12 months, dose 2
Symptoms: Received the Moderna booster on 10/25/21. A couple of days later I started experiencing burning gingiva, white spots inside the mouth, and the inside of my mouth, specially the palate, were extremely sensitive.
Healthcare visit (other): Dentist and PCP
Release 12 — day 35, dose 4
Symptoms: Since 6/20 I started having a mild shingles-like rash. As this happened after the 2nd booster and I also had a HZV Luke reaction in my mouth after the 1st booster, there may be a link here. Cortisone cream helps with rash/ itch. Seeking med care. cut off by CDC
Release 12 — 6 months, dose 4
Symptoms: The vision in my left eye deteriorated. There was retinal bleeding and then CRVO with macular edema, treated with Avastin. On 11/17 I suffered a total posterior posterior vitreous detachment.
Healthcare visit (other): Doctor visit, specialist, ER and a second retina specialist.
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 | Emergency care | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| SD | Coating in mouth | · | · | ✓ |
| SD | Emergency care | ✓ | ✓ | ✓ |
| SD | Gingival discomfort | · | · | ✓ |
| SD | Heart rate increased | ✓ | ✓ | ✓ |
| SD | Hypertension | ✓ | ✓ | ✓ |
| SD | Macular oedema | · | · | ✓ |
| SD | Oral disorder | · | · | ✓ |
| SD | Oral pain | · | · | ✓ |
| SD | Palpitations | ✓ | ✓ | ✓ |
| SD | Pruritus | · | · | ✓ |
| SD | Rash vesicular | · | · | ✓ |
| SD | Retinal haemorrhage | · | · | ✓ |
| SD | Retinal vein occlusion | · | · | ✓ |
| SD | Visual impairment | · | · | ✓ |
| SD | Vitreous detachment | · | · | ✓ |
| SRO | Syringe issue | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
| SRO | Vaccination error | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release