V3Y-42863-59750

2 vaccinations 5 coded responses 8 check-ins 5 free-text entries 5 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 919 / CA
Registered: 2021-06-04

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

Possible VAERS report

VAERS ID	Confidence	Score	Runner-up	Shared symptoms	Dose	State	VAERS vaccinated / onset / received	Call case
1464536 (opens in a new window)	high	11 / 11	2	5 of 9 VAERS symptoms	same dose (2)	CA matches	2021-05-27 / 2021-05-30 / 2021-07-12 received 50 days before the last call	case 968054

From the VAERS matching of call center cases (loader/vaers_match_*). Only the best match is shown, and only if it scores 8 or more out of 11. The score adds up timing (VAERS received soon after the call center contact), dose and shared symptoms; state only breaks ties. Confidence is high when the score is 8+ and at least 3 points ahead of the runner-up, medium when 5+ and 2 ahead, otherwise low. A match is a likely link, not a confirmed one.

Timeline

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

2021-04-04
Dose 1 — Moderna
2021-05-27
Dose 2 — Moderna
2021-06-04
Registered in v-safe
2021-06-04
Survey response — day 7, dose 2
MedDRA: Dysarthria, Emergency care, Hypersomnia, Thrombosis — Feeling: Good · Site: Pain, Redness · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I ended up in the ER on June 2, 2021 ans was told that I had a blood clot that had gone away on its own, after the second shot I couldnt think straight and was slurring in my speech. I slept a lot and it didnt occur to us that anything was wrong

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Report sent to call center — day 7, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-10
Survey response — day 14, dose 2
MedDRA: Emergency care, Fibrin D dimer increased, Hypertension, Peripheral swelling, Thrombosis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I got a blood clot that passed my right leg swelled and I went to the Er. My second shot was may 27 I was in the Er June 2 and had a post d-dider test which was 797 and now I have high blood pressure. I never had that before and now on bp meds.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-10
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-21
Call successful
Participant prefers to complete VAERS report online
2021-06-24
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-07-03
Survey response — day 35, dose 2
MedDRA: Office visit — 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, Emergency room or emergency department visit

Free text: Having medical issues that my doctor says is from the vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-03
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-07
Call 1 — Left Voicemail
2021-07-08
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-12
Call successful
Completed over the phone
2021-08-26
Survey response — 3 months, dose 2
MedDRA: Abdominal pain upper, Amnesia, Chest pain, Constipation, Diarrhoea, Emergency care, Gastric disorder, Pain — Feeling: Fair · 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, Emergency room or emergency department visit

Free text: Symptoms: Stomach issues, cramping, diaharera or constipation. Pains all around my stomach, I never had before. . New chest pains mainly in my right, stabbing,shooting very pain full. Im on heart BP meds for the first time in my life. Been I Er twice since · Healthcare visit (other): Ive been having memory loss

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-26
Report sent to call center — 3 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-08-31
Call 1 — Left Voicemail
2021-11-25
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Pain, Paraesthesia, Peripheral swelling, Thrombosis — Feeling: Good · 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, Emergency room or emergency department visit

Free text: Sever shoulder pain in the arm that I had the shots in. Never had problems with left shoulder. Also random body pains . Like being stuck by a needle in random places. Again never had that befor. I'm still on bp meds & swelling in r leg blood clot leg

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-01-13
Call 1 — Could Not Reach Participant
2022-01-18
Call 2 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-04	Moderna
2	2021-05-27	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-06-04	Successful	Participant prefers to complete VAERS report online
2021-06-10	Successful 2021-06-21	Participant prefers to complete VAERS report online
2021-07-03	Successful 2021-07-12	Completed over the phone
2021-08-26	Unsuccessful	Reported to VAERS during previous contact from GDIT
2021-11-25	Unsuccessful

Free text

Release 8 — day 7, dose 2

2021-06-04

Systemic reaction (other): I ended up in the ER on June 2, 2021 ans was told that I had a blood clot that had gone away on its own, after the second shot I couldnt think straight and was slurring in my speech. I slept a lot and it didnt occur to us that anything was wrong

Release 9 — day 14, dose 2

2021-06-10

Symptoms: I got a blood clot that passed my right leg swelled and I went to the Er. My second shot was may 27 I was in the Er June 2 and had a post d-dider test which was 797 and now I have high blood pressure. I never had that before and now on bp meds.

Release 9 — day 35, dose 2

2021-07-03

Symptoms: Having medical issues that my doctor says is from the vaccine

Release 9 — 3 months, dose 2

2021-08-26

Symptoms: Stomach issues, cramping, diaharera or constipation. Pains all around my stomach, I never had before. . New chest pains mainly in my right, stabbing,shooting very pain full. Im on heart BP meds for the first time in my life. Been I Er twice since

Healthcare visit (other): Ive been having memory loss

Release 10 — 6 months, dose 2

2021-11-25

Symptoms: Sever shoulder pain in the arm that I had the shots in. Never had problems with left shoulder. Also random body pains . Like being stuck by a needle in random places. Again never had that befor. I'm still on bp meds & swelling in r leg blood clot leg cut off by CDC

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	Amnesia	✓	·	✓
SD	Abdominal pain upper	✓	·	✓
SD	Arthralgia	·	·	✓
SD	Chest pain	✓	·	✓
SD	Constipation	✓	·	✓
SD	Diarrhoea	✓	·	✓
SD	Emergency care	✓	✓	✓
SD	Fibrin D dimer increased	✓	✓	✓
SD	Gastric disorder	✓	·	✓
SD	Hypertension	✓	✓	✓
SD	Office visit	✓	✓	✓
SD	Pain	✓	·	✓
SD	Paraesthesia	·	·	✓
SD	Peripheral swelling	✓	✓	✓
SD	Thrombosis	✓	✓	✓
SRO	Dysarthria	✓	✓	✓
SRO	Emergency care	✓	✓	✓
SRO	Hypersomnia	✓	✓	✓
SRO	Thrombosis	✓	✓	✓

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