7LD-21703-48880

3 vaccinations 11 coded responses 23 check-ins 11 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 327 / FL
Registered: 2021-01-18

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-05
Dose 1 — Moderna
2021-01-18
Registered in v-safe
2021-01-18
Survey response — day 7, dose 1
MedDRA: Eyelid rash, Injection site rash — Feeling: Good · Site: Redness · Rash, not including the immediate area around the injection site

Free text: Rash circle on right bottom eyelid started about 1/12. Two bigger seperate rash circles near inj site noticed 1/17.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-01-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-02
Dose 2 — Moderna
2021-02-02
Health check-in — day 0, dose 2
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-02-03
Survey response — days 1–6 daily, dose 2
MedDRA: Respiratory tract congestion — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Congestion

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

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness · Chills, Fatigue or tiredness, Nausea

Adult check-in
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Respiratory tract congestion — Feeling: Good · Site: Redness · Fatigue or tiredness, Nausea

Free text: Congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema of eyelid, Eyelid rash, Injection site bruising, Swelling of eyelid — Feeling: Good · Site: Redness · Rash, not including the immediate area around the injection site

Free text: Have had a rash on lower eyelid since right after first vaccine. This weekend, developed punk swollen upper eyelid. Seeing doctor Wed. Also small yellowing bruise at injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Health check-in — day 7, dose 2
Feeling: Good · Site: Redness · Nausea

Adult check-in
2021-02-16
Survey response — day 14, dose 2
MedDRA: Headache, Oropharyngeal pain, Sneezing — Feeling: Fair

Free text: Sore throat, headache, sneezing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-02
Survey response — day 28, dose 2
MedDRA: Dizziness, Headache, Impaired driving ability — Feeling: Poor

Free text: Yesterday I almost passed out while driving. Today I have a headache. Have call in to my cardiologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-16
Survey response — day 42, dose 2
MedDRA: Abdominal discomfort, Diarrhoea, Heart rate irregular, Influenza like illness, Nausea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Flu-like symptoms. Irreg heartbeat worsened for about 5 days. On Friday, stomach was very upset, had diarrhea. Monday morn felt like I was going to vomit. Started feeling better, then husband was sick, vomiting in evening (same vaccine and dates).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-03
Survey response — 6 months, dose 2
MedDRA: Arthritis, Emergency care, Office visit, Peripheral swelling, Peripheral venous disease, Physiotherapy, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Symptoms: Arthritis in hands is getting worse - had it most of my adult life, exacerbated by chemo, I believe. Also, swelling in legs, due to venous insufficiency. Also may have been exacerbated by chemo (2016 - 2017) · Healthcare visit (other): Cardio visit for legs, after ER. Physical therapy for hands.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-03
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-25
Dose 3 — Moderna
2021-10-15
Call 2 — Left Voicemail
2021-10-25
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-10-30
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-06
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-25
Survey response — 3 months, dose 3
MedDRA: Arthritis, Back disorder, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Left bottom of back went out due to arthritis in my spine. Not related to vaccine. · Healthcare visit (other): Orthopaedic clinic

MedDRA releases: 2024-11 · check-in free text available
2021-12-25
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-27
Call 2 — Left Voicemail
2022-03-28
Survey response — 6 months, dose 3
MedDRA: Asthenia, Back pain, Condition aggravated, Malignant polyp, Pre-existing disease, Uterine dilation and curettage — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Had D&C. Carcinoma found in polyp. Will have hysterectomy. I'm a prior breast cancer survivor. Chemo made venous insufficiency in legs worse since last check-in. Experienced debilitating back pain for two months in the Fall.

MedDRA releases: 2024-11 · check-in free text available
2022-03-28
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-30
Call 1 — Left Voicemail
2022-09-25
Survey response — 12 months, dose 3
MedDRA: Back pain, Physiotherapy, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Symptoms: Uterine cancer. Followed by hysterectomy and 6 months of chemo. Sever back pains not associated with the cancer. · Healthcare visit (other): Chemo. Physical therapy.

MedDRA releases: 2024-11 · check-in free text available
2022-09-25
Report sent to call center — 12 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-09-26
Call 1 — Left Voicemail
2022-09-26
Call 1 — Left Voicemail
2022-09-26
Call 2 — Left Voicemail
2022-09-26
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-05	Moderna
2	2021-02-02	Moderna
3	2021-09-25	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-08-03	Unsuccessful
2021-12-25	Unsuccessful
2022-03-28	Unsuccessful
2022-09-25	Unsuccessful

Free text

Release 2 — day 7, dose 1

2021-01-18

Systemic reaction (other): Rash circle on right bottom eyelid started about 1/12. Two bigger seperate rash circles near inj site noticed 1/17.

Release 3 — days 1–6 daily, dose 2

2021-02-03

Systemic reaction (other): Congestion

2021-02-06

Systemic reaction (other): Congestion

2021-02-08

Systemic reaction (other): Have had a rash on lower eyelid since right after first vaccine. This weekend, developed punk swollen upper eyelid. Seeing doctor Wed. Also small yellowing bruise at injection site.

Release 4 — day 14, dose 2

2021-02-16

Symptoms: Sore throat, headache, sneezing

Release 4 — day 28, dose 2

2021-03-02

Symptoms: Yesterday I almost passed out while driving. Today I have a headache. Have call in to my cardiologist.

Release 5 — day 42, dose 2

2021-03-16

Symptoms: Flu-like symptoms. Irreg heartbeat worsened for about 5 days. On Friday, stomach was very upset, had diarrhea. Monday morn felt like I was going to vomit. Started feeling better, then husband was sick, vomiting in evening (same vaccine and dates). cut off by CDC

Release 9 — 6 months, dose 2

2021-08-03

Symptoms: Arthritis in hands is getting worse - had it most of my adult life, exacerbated by chemo, I believe. Also, swelling in legs, due to venous insufficiency. Also may have been exacerbated by chemo (2016 - 2017)

Healthcare visit (other): Cardio visit for legs, after ER. Physical therapy for hands.

Release 10 — 3 months, dose 3

2021-12-25

Symptoms: Left bottom of back went out due to arthritis in my spine. Not related to vaccine.

Healthcare visit (other): Orthopaedic clinic

Release 11 — 6 months, dose 3

2022-03-28

Symptoms: Had D&C. Carcinoma found in polyp. Will have hysterectomy. I'm a prior breast cancer survivor. Chemo made venous insufficiency in legs worse since last check-in. Experienced debilitating back pain for two months in the Fall.

Release 12 — 12 months, dose 3

2022-09-25

Symptoms: Uterine cancer. Followed by hysterectomy and 6 months of chemo. Sever back pains not associated with the cancer.

Healthcare visit (other): Chemo. Physical therapy.

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	✓	·	✓
HCVO	Physiotherapy	✓	·	✓
HCVO	Pre-existing disease	·	·	✓
SD	Abdominal discomfort	✓	✓	✓
SD	Arthritis	✓	·	✓
SD	Asthenia	·	·	✓
SD	Back disorder	·	·	✓
SD	Back pain	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Heart rate irregular	✓	✓	✓
SD	Impaired driving ability	✓	✓	✓
SD	Influenza like illness	✓	✓	✓
SD	Malignant polyp	·	·	✓
SD	Nausea	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Peripheral swelling	✓	·	✓
SD	Peripheral venous disease	✓	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Sneezing	✓	✓	✓
SD	Uterine dilation and curettage	·	·	✓
SRO	Erythema of eyelid	✓	✓	✓
SRO	Eyelid rash	✓	✓	✓
SRO	Injection site bruising	✓	✓	✓
SRO	Injection site rash	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Swelling of eyelid	✓	✓	✓

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