6W5-21062-13801 · OpenVSafe

Timeline

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

2021-02-17
Dose 1 — Moderna
2021-03-06
Registered in v-safe
2021-03-06
Survey response — day 14, dose 1
MedDRA: Adverse reaction, Incomplete course of vaccination, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Indicated 17 days of adverse effects of my 1st dose but dont know if it came thru. Because of these adverse effects my doctor has advised me not to get the 2nd dose. · Healthcare visit (other): Dr office

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-10
Survey response — day 21, dose 1
MedDRA: Immunisation reaction, Office visit, Pruritus, Skin discolouration, Urticaria — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Adverse reaction (skin welt on full upper arm) has gone. Slight discoloration still present but getting lighter. Itching continues (not constant). Completed antibiotics. Doctor still advises not to get 2nd dose as my immune system went into overdrive · Healthcare visit (other): Doctors office visits (4)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Survey response — day 28, dose 1
MedDRA: Adverse reaction, Blood urine present, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Blood in urine. Thought it could be UTI. Doctor thinks it is still linked to adverse reaction after 1st dose of vaccine. Doing culture. Doctor still advises not to get 2nd dose. · Healthcare visit (other): Doctor office visit.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Report sent to call center — day 28, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-26
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-03-31
Health check-in — day 42, dose 1
Feeling: Good

Adult check-in
2021-05-19
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-08-18
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2021-11-28
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-02-17
Health check-in — 12 months, dose 1
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-17	Moderna

Call center

3 call center cases

3 successful

VAERS report filed, before or during a call: 3

See the call center timeline

Free text

Release 5 — day 14, dose 1

2021-03-06

Symptoms: Indicated 17 days of adverse effects of my 1st dose but dont know if it came thru. Because of these adverse effects my doctor has advised me not to get the 2nd dose.

Healthcare visit (other): Dr office

Release 5 — day 21, dose 1

2021-03-10

Symptoms: Adverse reaction (skin welt on full upper arm) has gone. Slight discoloration still present but getting lighter. Itching continues (not constant). Completed antibiotics. Doctor still advises not to get 2nd dose as my immune system went into overdrive cut off by CDC

Healthcare visit (other): Doctors office visits (4)

Release 6 — day 28, dose 1

2021-03-19

Symptoms: Blood in urine. Thought it could be UTI. Doctor thinks it is still linked to adverse reaction after 1st dose of vaccine. Doing culture. Doctor still advises not to get 2nd dose.

Healthcare visit (other): Doctor office visit.

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	Adverse reaction	✓	✓	✓
SD	Blood urine present	✓	✓	✓
SD	Immunisation reaction	✓	✓	✓
SD	Incomplete course of vaccination	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Skin discolouration	✓	✓	✓
SD	Urticaria	✓	✓	✓

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