V9V-30428-39544

3 vaccinations 7 coded responses 24 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 600 / IL
Registered: 2021-01-14

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

2021-01-14
Registered in v-safe
2021-01-15
Dose 1 — Moderna
2021-01-15
Survey response — day 0, dose 1
MedDRA: Dizziness, Dry eye, Vision blurred — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Dry eyes, dizzy, hazy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Report sent to call center — day 0, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Dry eye, Eye pruritus — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Itchy dry eyes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Survey response — days 1–6 daily, dose 1
MedDRA: Dry eye, Eye pruritus — Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Free text: Itchy and dry eyes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Dry eye — Feeling: Fair · Headache, Diarrhea, Abdominal pain

Free text: Dry eyes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-01-22
Health check-in — day 7, dose 1
Feeling: Good · Site: Itching · Headache

Adult check-in
2021-01-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-12
Dose 2 — Moderna
2021-02-12
Survey response — day 0, dose 2
MedDRA: Eye pruritus, Ocular hyperaemia — Feeling: Fair · Site: Pain, Itching · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Itchy red eyes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Itching · Headache, Fatigue or tiredness, Diarrhea

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-19
Health check-in — day 7, dose 2
Feeling: Fair · Headache · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-13
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-28
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-19
Survey response — 3 months, dose 2
MedDRA: Dizziness, Ulcer — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Dizzy, ulcer,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-16
Call 1 — Left Voicemail
2021-08-13
Survey response — 6 months, dose 2
MedDRA: Gastritis, Ulcer — Feeling: Good · 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: Gastritis, ulcer

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-13
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

1 call case(s)
2021-08-19
Call 1 — Left Voicemail
2021-11-16
Dose 3 — Moderna
Co-administered: Flu
2022-02-13
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-12	Moderna
3	2021-11-16	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-01-15	priority 2/3
2021-05-19	Unsuccessful
2021-08-13	Unsuccessful

Free text

Release 2 — day 0, dose 1

2021-01-15

Systemic reaction (other): Dry eyes, dizzy, hazy

Release 2 — days 1–6 daily, dose 1

2021-01-16

Systemic reaction (other): Itchy dry eyes

2021-01-17

Systemic reaction (other): Itchy and dry eyes

2021-01-19

Systemic reaction (other): Dry eyes

Release 4 — day 0, dose 2

2021-02-12

Systemic reaction (other): Itchy red eyes

Release 8 — 3 months, dose 2

2021-05-19

Symptoms: Dizzy, ulcer,

Release 9 — 6 months, dose 2

2021-08-13

Symptoms: Gastritis, ulcer

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	Dizziness	✓	✓	✓
SD	Gastritis	✓	·	✓
SD	Ulcer	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dry eye	✓	✓	✓
SRO	Eye pruritus	✓	✓	✓
SRO	Ocular hyperaemia	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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