RC5-14813-00821

3 vaccinations 9 coded responses 37 check-ins 6 free-text entries 5 call cases

Sex: Female
Age at first dose: 0-4
ZIP prefix: 209 / MD
Registered: 2022-06-25

Relationship: Child or adolescent in my care
Guardian: ZBL-76515-88683
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

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

2022-06-25
Registered in v-safe
2022-06-25
Dose 1 — Moderna
2022-06-25
Health check-in — day 0, dose 1, under 3
Feeling: Good · None

Under 3 check-in
2022-06-26
Survey response — days 1–6 daily, dose 1, under 3
MedDRA: Diabetes mellitus, Pre-existing disease — Feeling: Good

Free text: She is diabetic and her numbers have been out of control high.

MedDRA releases: 2024-11 · check-in free text available
2022-06-28
Health check-in — days 1–6 daily, dose 1, under 3
Feeling: Fair · Irritability/crying

Under 3 check-in
2022-06-29
Health check-in — days 1–6 daily, dose 1, under 3
Feeling: Good · None

Under 3 check-in
2022-06-30
Health check-in — days 1–6 daily, dose 1, under 3
Feeling: Good · None

Under 3 check-in
2022-07-01
Health check-in — days 1–6 daily, dose 1, under 3
Feeling: Good · None

Under 3 check-in
2022-07-03
Health check-in — day 7, dose 1, under 3
Feeling: Good · None

Under 3 check-in
2022-07-09
Health check-in — day 14, dose 1, under 3
Feeling: Good

Under 3 check-in
2022-07-16
Health check-in — day 21, dose 1, under 3
Feeling: Good

Under 3 check-in
2022-07-23
Dose 2 — Moderna
2022-07-24
Health check-in — days 1–6 daily, dose 2, under 3
Feeling: Fair · Site: Pain · None

Under 3 check-in
2022-07-25
Survey response — days 1–6 daily, dose 2, under 3
MedDRA: Diabetes mellitus, Pre-existing disease — Feeling: Good

Free text: She has type 1 diabetes, and her blood sugar has been difficult to manage.

MedDRA releases: 2024-11 · check-in free text available
2022-07-26
Survey response — days 1–6 daily, dose 2, under 3
MedDRA: Pre-existing disease — Feeling: Good

Free text: type 1 diabetic and her blood glucose levels are unpredictable

MedDRA releases: 2024-11 · check-in free text available
2022-07-27
Health check-in — days 1–6 daily, dose 2, under 3
Feeling: Good · None

Under 3 check-in
2022-07-28
Health check-in — days 1–6 daily, dose 2, under 3
Feeling: Good · None

Under 3 check-in
2022-07-29
Health check-in — days 1–6 daily, dose 2, under 3
Feeling: Good · None

Under 3 check-in
2022-07-30
Health check-in — day 7, dose 2, under 3
Feeling: Good · None

Under 3 check-in
2022-08-06
Health check-in — day 14, dose 2, under 3
Feeling: Good

Under 3 check-in
2022-08-13
Health check-in — day 21, dose 2, under 3
Feeling: Good

Under 3 check-in
2022-08-20
Health check-in — day 28, dose 2, under 3
Feeling: Good

Under 3 check-in
2022-08-27
Health check-in — day 35, dose 2, under 3
Feeling: Good

Under 3 check-in
2022-09-03
Health check-in — day 42, dose 2, under 3
Feeling: Good

Under 3 check-in
2022-10-22
Survey response — 3 months, dose 2, under 3
MedDRA: Hand-foot-and-mouth disease, Rhinorrhoea — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Extended runny nose followed by hand, foot, mouth disease

MedDRA releases: 2024-11 · check-in free text available
2022-10-22
Report sent to call center — 3 months, dose 2, under 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-25
Call 3 — Left Voicemail
2022-12-20
Dose 3 — Moderna
2022-12-20
Health check-in — day 0, dose 3, under 3
Feeling: Poor · Fever · Sleepiness, Irritability/crying, Loss of appetite · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Under 3 check-in
2022-12-20
Report sent to call center — day 0, dose 3, under 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-12-21
Survey response — days 1–6 daily, dose 3, under 3
MedDRA: Conjunctivitis — Feeling: Poor · Fever · Sleepiness, Irritability/crying, Loss of appetite · Be unable to work or attend school

Free text: Conjunctivitis

MedDRA releases: 2024-11 · check-in free text available
2022-12-21
Call 3 — Left Voicemail
2022-12-22
Health check-in — days 1–6 daily, dose 3, under 3
Feeling: Poor · Site: Redness · Fever · Sleepiness, Irritability/crying, Loss of appetite · Be unable to work or attend school, Be unable to do your normal daily activities

Under 3 check-in
2022-12-23
Health check-in — days 1–6 daily, dose 3, under 3
Feeling: Fair · None

Under 3 check-in
2022-12-24
Health check-in — days 1–6 daily, dose 3, under 3
Feeling: Fair · Irritability/crying, Loss of appetite · Be unable to do your normal daily activities

Under 3 check-in
2022-12-25
Health check-in — days 1–6 daily, dose 3, under 3
Feeling: Fair · Loss of appetite

Under 3 check-in
2022-12-26
Survey response — days 1–6 daily, dose 3, under 3
MedDRA: Blood glucose decreased, Pre-existing disease — Feeling: Fair

Free text: She has type 1 diabetes and had been having several major low blood sugar events

MedDRA releases: 2024-11 · check-in free text available
2022-12-27
Health check-in — day 7, dose 3, under 3
Feeling: Fair · None · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Under 3 check-in
2022-12-27
Report sent to call center — day 7, dose 3, under 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-12-28
Call X — Left Voicemail
2022-12-28
Call X — Left Voicemail
2022-12-28
Call 3 — Left Voicemail
2023-01-03
Health check-in — day 14, dose 3, under 3
Feeling: Fair

Under 3 check-in
2023-01-10
Survey response — day 21, dose 3, under 3
MedDRA: Vomiting — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-01-10
Report sent to call center — day 21, dose 3, under 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2023-01-11
Call 1 — Left Voicemail
2023-01-11
Call 1 — Left Voicemail
2023-01-11
Call 1 — Left Voicemail
2023-01-11
Call 1 — Left Voicemail
2023-01-17
Health check-in — day 28, dose 3, under 3
Feeling: Good

Under 3 check-in
2023-01-26
Health check-in — day 35, dose 3, under 3
Feeling: Good

Under 3 check-in
2023-01-31
Survey response — day 42, dose 3, under 3
MedDRA: Decreased appetite, Lethargy, Pyrexia, Vomiting — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-01-31
Report sent to call center — day 42, dose 3, under 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2023-02-01
Call 2 — Left Voicemail
2023-02-01
Call 2 — Left Voicemail
2023-02-01
Call 2 — Left Voicemail
2023-02-01
Call 2 — Left Voicemail
2023-02-01
Call 1 — Left Voicemail
2023-03-21
Health check-in — 3 months, dose 3, under 3
Feeling: Good

Under 3 check-in
2023-06-20
Survey response — 6 months, dose 3, under 3
MedDRA: Adverse drug reaction, Pharyngitis streptococcal — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2022-06-25	Moderna	No
2	2022-07-23	Moderna	No
3	2022-12-20	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-10-22	Unsuccessful
2022-12-20	Unsuccessful
2022-12-27	Unsuccessful
2023-01-10	Unsuccessful
2023-01-31	Unsuccessful

Free text

Release 12 (Under 3) — days 1–6 daily, dose 1, under 3

2022-06-26

Systemic reaction (other): She is diabetic and her numbers have been out of control high.

Release 12 (Under 3) — days 1–6 daily, dose 2, under 3

2022-07-25

Systemic reaction (other): She has type 1 diabetes, and her blood sugar has been difficult to manage.

2022-07-26

Systemic reaction (other): type 1 diabetic and her blood glucose levels are unpredictable

Release 12 (Under 3) — 3 months, dose 2, under 3

2022-10-22

Symptoms: Extended runny nose followed by hand, foot, mouth disease

Release 12 (Under 3) — days 1–6 daily, dose 3, under 3

2022-12-21

Systemic reaction (other): Conjunctivitis

2022-12-26

Systemic reaction (other): She has type 1 diabetes and had been having several major low blood sugar events

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
SD	Adverse drug reaction	·	·	✓
SD	Decreased appetite	·	·	✓
SD	Hand-foot-and-mouth disease	·	·	✓
SD	Lethargy	·	·	✓
SD	Pharyngitis streptococcal	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Vomiting	·	·	✓
SRO	Blood glucose decreased	·	·	✓
SRO	Conjunctivitis	·	·	✓
SRO	Diabetes mellitus	·	·	✓
SRO	Pre-existing disease	·	·	✓

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