6P4-19844-06599

4 vaccinations 6 coded responses 22 check-ins 6 free-text entries 5 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 750 / TX
Registered: 2020-12-31

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2020-12-31
Registered in v-safe
2020-12-31
Dose 1 — Moderna
2020-12-31
Health check-in — day 0, dose 1
Feeling: Good · None

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

Adult check-in
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-05
Survey response — days 1–6 daily, dose 1
MedDRA: Diplopia, Office visit, Vision blurred — Feeling: Fair · Headache · Be unable to work, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Blurred vision, double vision · Healthcare visit (other): Primary MD, appointment w/ophthalmologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-05
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-06
Survey response — days 1–6 daily, dose 1
MedDRA: Cranial nerve paralysis, Office visit — Feeling: Poor · Headache · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Diagnosed with 3rd cranial nerve palsy · Healthcare visit (other): Ophthalmologist, ct of head/orbit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-06
Report sent to call center — days 1–6 daily, 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)
2021-01-07
Survey response — day 7, dose 1
MedDRA: IIIrd nerve paralysis, Unevaluable event — Feeling: Poor · Headache, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Developed 3rd cranial nerve palsy on 1/5 · Healthcare visit (other): CT scan yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-07
Report sent to call center — day 7, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-16
Health check-in — day 14, dose 1
Feeling: Poor

Adult check-in
2021-01-21
Survey response — day 21, dose 1
MedDRA: Computerised tomogram, Eye movement disorder, Eyelid ptosis, Facial paralysis, Headache, Impaired driving ability, Office visit, Paralysis, Specialist consultation — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: My right eye lid is closed, my eye ball is rotated down and out. Facial paralysis developed 5 days post vaccine on 1/5/21. No improvement noted. Can not drive to work and have headache throughout the day · Healthcare visit (other): Visit to primary md, ophthalmologist, had CT scan of head/orbit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
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)
2021-01-28
Survey response — day 28, dose 1
MedDRA: Facial paralysis, Headache — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Facial paralysis, droopy eye lid, pupil turned out and down. Persistent headache. Will not be taking 2nd vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Dose 2 — Moderna
2021-02-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

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

Adult check-in
2021-02-11
Call successful
Does not wish to fill out VAERS report
2021-02-11
Call successful
Does not wish to fill out VAERS report
2021-02-11
Call successful
Does not wish to fill out VAERS report
2021-02-16
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-25
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
2021-05-04
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-05
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Back pain, Pain in extremity, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Back, hip and leg pain · Healthcare visit (other): Appointment for next week

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-05
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)
2021-08-18
Call 1 — Left Voicemail
2021-08-27
Dose 3 — Moderna
2022-03-31
Dose 4 — Moderna

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-31	Moderna
2	2021-02-02	Moderna
3	2021-08-27	Moderna	No
4	2022-03-31	Moderna	No

Call center

5 call center cases

4 successful · 1 unsuccessful

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-05

Systemic reaction (other): Blurred vision, double vision

Healthcare visit (other): Primary MD, appointment w/ophthalmologist

2021-01-06

Systemic reaction (other): Diagnosed with 3rd cranial nerve palsy

Healthcare visit (other): Ophthalmologist, ct of head/orbit

Release 1 — day 7, dose 1

2021-01-07

Systemic reaction (other): Developed 3rd cranial nerve palsy on 1/5

Healthcare visit (other): CT scan yesterday

Release 2 — day 21, dose 1

2021-01-21

Symptoms: My right eye lid is closed, my eye ball is rotated down and out. Facial paralysis developed 5 days post vaccine on 1/5/21. No improvement noted. Can not drive to work and have headache throughout the day

Healthcare visit (other): Visit to primary md, ophthalmologist, had CT scan of head/orbit

Release 2 — day 28, dose 1

2021-01-28

Symptoms: Facial paralysis, droopy eye lid, pupil turned out and down. Persistent headache. Will not be taking 2nd vaccine

Release 9 — 6 months, dose 2

2021-08-05

Symptoms: Back, hip and leg pain

Healthcare visit (other): Appointment for next week

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	Computerised tomogram	○	✓	○
HCVO	Computerised tomogram head	○	○	○
HCVO	Office visit	✓	✓	✓
HCVO	Self-medication	○	○	○
HCVO	Specialist consultation	○	✓	○
HCVO	Unevaluable event	✓	✓	✓
SD	Arthralgia	✓	·	✓
SD	Back pain	✓	·	✓
SD	Eye movement disorder	✓	·	✓
SD	Eyelid ptosis	✓	·	✓
SD	Facial paralysis	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Impaired driving ability	✓	·	✓
SD	Pain in extremity	✓	·	✓
SD	Paralysis	○	✓	○
SRO	Cranial nerve paralysis	✓	✓	✓
SRO	Diplopia	✓	✓	✓
SRO	IIIrd nerve paralysis	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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