64E-10055-09045
2 vaccinations
4 coded responses
5 check-ins
4 free-text entries
4 call cases
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 928 / CA
- Registered
- 2021-04-10
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-01
Dose 1 — Moderna
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2021-03-29
Dose 2 — Moderna
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2021-04-10
Registered in v-safe
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2021-04-10
Survey response — day 7, dose 2MedDRA: Headache, Lip swelling, Swollen tongue — Feeling: Poor · Site: Pain · Headache · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Swollen tongue/ lips x 7 days started 2 days after 2nd vaccine headacheMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-10
Report sent to call center — day 7, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-12
Survey response — day 14, dose 2MedDRA: Lip swelling, Office visit, Swollen tongue — Feeling: Poor · Get care from a doctor or other healthcare professionalFree text: Symptoms: Tongue and lips still swollen Went to Dr today going on prednisone 10mg for 5 days · Healthcare visit (other): In person visit to drMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-12
Report sent to call center — day 14, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-20
Survey response — day 21, dose 2MedDRA: Dry mouth, Lip swelling, Swollen tongue, Tongue discomfort — Feeling: Poor · 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 visitFree text: Mouth tongue burningLips swollen on inside very dry mouth. Been to the dentist twice and the dr four times, have had blood test CBC/vitamin B12 folate came back normal. Referred to ENTIts now been 20 days since 2nd vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-20
Report sent to call center — day 21, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-06-28
Survey response — 3 months, dose 2MedDRA: Dry mouth — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: I have been diagnosed with Dry mouth syndrome. Started 36 hrs after 2nd vaccine. I have had all blood work and CT to rule out autoamune disorder.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-28
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-06-29
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2021-06-30
Call successfulCompleted over the phone
- 2021-09-27
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-01 | Moderna | |
| 2 | 2021-03-29 | Moderna |
Call center
4 call center cases
4 successful
VAERS report filed, before or during a call: 4
Free text
Release 7 — day 7, dose 2
Systemic reaction (other): Swollen tongue/ lips x 7 days started 2 days after 2nd vaccine headache
Release 7 — day 14, dose 2
Symptoms: Tongue and lips still swollen Went to Dr today going on prednisone 10mg for 5 days
Healthcare visit (other): In person visit to dr
Release 7 — day 21, dose 2
Symptoms: Mouth tongue burningLips swollen on inside very dry mouth. Been to the dentist twice and the dr four times, have had blood test CBC/vitamin B12 folate came back normal. Referred to ENTIts now been 20 days since 2nd vaccine
Release 9 — 3 months, dose 2
Symptoms: I have been diagnosed with Dry mouth syndrome. Started 36 hrs after 2nd vaccine. I have had all blood work and CT to rule out autoamune disorder.
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 | Dry mouth | ✓ | ✓ | ✓ |
| SD | Lip swelling | ✓ | ✓ | ✓ |
| SD | Office visit | ✓ | ✓ | ✓ |
| SD | Swollen tongue | ✓ | ✓ | ✓ |
| SD | Tongue discomfort | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Lip swelling | ✓ | ✓ | ✓ |
| SRO | Swollen tongue | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release