6UR-13427-40538

1 vaccination 9 coded responses 9 check-ins 9 free-text entries 8 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 917 / CA
Registered: 2021-03-01

Relationship: Self
Race: Asian
Ethnicity: N/A

Timeline

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

2021-02-25
Dose 1 — Moderna
2021-03-01
Registered in v-safe
2021-03-01
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Back pain, Headache, Musculoskeletal pain, Pain in extremity — Feeling: Fair · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Shooting pain in arm, back, shoulder blades, ankle, back of the head

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-05
Survey response — day 7, dose 1
MedDRA: Asthenopia, Vision blurred — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Blurriness in left eye on and off and heavy eye

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Report sent to call center — day 7, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-14
Survey response — day 14, dose 1
MedDRA: Back pain, Headache, Hypoaesthesia, Vision blurred — Feeling: Fair · 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 visit

Free text: Blurry visionNumbness in both arms, left leg , head aches, fatiyBack ache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-18
Survey response — day 21, dose 1
MedDRA: Abdominal pain upper, Decreased appetite, Headache — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Head ache, stomach pain, low appetite.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-25
Survey response — day 28, dose 1
MedDRA: Decreased appetite, Eye inflammation, Pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Left eye vision ...there is a dry patch and inflammation in left eye . Sometimes very pintching pain again in different parts of body. Appetite is very low.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Report sent to call center — day 28, dose 1
Get care from a doctor or other healthcare professional

no matching call case
2021-04-06
Survey response — day 35, dose 1
MedDRA: Appetite disorder, Arthralgia, Fatigue, Headache, Joint swelling, Vision blurred — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Pain in kneesinflammatotion and blurry vision in left eyeLow appetiteVery tired and head ache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Report sent to call center — day 35, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-08
Survey response — day 42, dose 1
MedDRA: Decreased appetite, Joint swelling, Vision blurred, Weight decreased — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Inflammation in knees Left eye blurry vision Low appetite Lost weight

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Report sent to call center — day 42, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-29
Survey response — 3 months, dose 1
MedDRA: Abnormal sensation in eye, Arthralgia, Eye inflammation, Limb discomfort, Office visit, Pain in extremity, Visual impairment — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Pain in elbow and knees, vision is going down in left eye and always feeling something in eye. Also inflammation in left eye.Right arm pain and discomfort, · Healthcare visit (other): Optometrist every week

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-29
Report sent to call center — 3 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-21
Call 1 — Left Voicemail
2021-06-21
Call successful
Participant prefers to complete VAERS report online
2021-08-26
Survey response — 6 months, dose 1
MedDRA: Arthralgia, Pain, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: VisionElbow tinting Knee pain Body pain

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-26
Report sent to call center — 6 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-31
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-25	Moderna

Call center

8 call center cases

7 successful · 1 unsuccessful

1 check-in flagged for a call with no call center case on record

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-03-01

Systemic reaction (other): Shooting pain in arm, back, shoulder blades, ankle, back of the head

Release 5 — day 7, dose 1

2021-03-05

Systemic reaction (other): Blurriness in left eye on and off and heavy eye

Release 5 — day 14, dose 1

2021-03-14

Symptoms: Blurry visionNumbness in both arms, left leg , head aches, fatiyBack ache

Release 5 — day 21, dose 1

2021-03-18

Symptoms: Head ache, stomach pain, low appetite.

Release 6 — day 28, dose 1

2021-03-25

Symptoms: Left eye vision ...there is a dry patch and inflammation in left eye . Sometimes very pintching pain again in different parts of body. Appetite is very low.

Release 7 — day 35, dose 1

2021-04-06

Symptoms: Pain in kneesinflammatotion and blurry vision in left eyeLow appetiteVery tired and head ache

Release 7 — day 42, dose 1

2021-04-08

Symptoms: Inflammation in knees Left eye blurry vision Low appetite Lost weight

Release 8 — 3 months, dose 1

2021-05-29

Symptoms: Pain in elbow and knees, vision is going down in left eye and always feeling something in eye. Also inflammation in left eye.Right arm pain and discomfort,

Healthcare visit (other): Optometrist every week

Release 9 — 6 months, dose 1

2021-08-26

Symptoms: VisionElbow tinting Knee pain Body pain

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	Abdominal pain upper	✓	✓	✓
SD	Abnormal sensation in eye	✓	✓	✓
SD	Appetite disorder	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Decreased appetite	✓	✓	✓
SD	Eye inflammation	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Joint swelling	✓	✓	✓
SD	Limb discomfort	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Unevaluable event	✓	·	✓
SD	Vision blurred	✓	✓	✓
SD	Visual impairment	✓	✓	✓
SD	Weight decreased	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Asthenopia	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Musculoskeletal pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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