VT6-10117-11706

2 vaccinations 9 coded responses 19 check-ins 9 free-text entries 4 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 060 / CT
Registered: 2021-01-27

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

2021-01-26
Dose 1 — Moderna
2021-01-27
Registered in v-safe
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Tremor — Feeling: Poor · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to work, Be unable to do your normal daily activities

Free text: Shakiness in my right arm (the arm that was injected).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Survey response — days 1–6 daily, dose 1
MedDRA: Palpitations — Feeling: Fair · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Palpitations since the day of the shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Abdominal pain

Adult check-in
2021-02-02
Survey response — day 7, dose 1
MedDRA: Urticaria — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Ive had intermittent hives/urticaria since the injection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-02-17
Survey response — day 21, dose 1
MedDRA: Abortion spontaneous, Pregnancy — Feeling: Poor · Be unable to do your normal daily activities

Free text: I had a miscarriage. I did not know I was pregnant when I took the vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-02-25
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-02
Health check-in — day 35, dose 1
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 42, dose 1
Feeling: Fair

Adult check-in
2021-03-16
Dose 2 — Moderna
2021-03-18
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Dyspnoea, Mobility decreased, Muscular weakness, SARS-CoV-2 test negative, Syncope — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Arm became weak and I could not move my arm without assistance from other arm by 5pm the day of shot. My rxs were so severe globally that I almost went to the ED. I was dizzy, felt faint, short of breath, severe rxn · Healthcare visit (other): Covid test - negative

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Survey response — days 1–6 daily, dose 2
MedDRA: Cold sweat — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Clammy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — days 1–6 daily, dose 2
MedDRA: Loss of personal independence in daily activities, Muscle spasms, Muscle tightness, Muscular weakness, Pain in extremity — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Yesterday the muscles in my left hand were spasming and it was difficult to drive. My left arm still feels achy and weak. The muscles that tightened up are still super tight.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Health check-in — day 7, dose 2
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-04-01
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-06
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-22
Survey response — day 35, dose 2
MedDRA: Asthma, Fatigue, Unevaluable event, Visual impairment — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: I have had vision changes. I cannot read close up. My last appt my doc said I didnt need reading glasses. After severe reaction to 2nd shot I had to increase my font on all devices and cant read at arms length. Also rundown in general. Asthmat · Healthcare visit (other): I will FU with my eye doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-15
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-06-15
Call 1 — Left Voicemail
2021-09-16
Health check-in — 6 months, dose 2
Feeling: Poor

Adult check-in
2022-03-16
Survey response — 12 months, dose 2
MedDRA: Arthralgia, Lung disorder, Muscular weakness, Pain in extremity, Visual impairment — Feeling: Poor · 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

Free text: The joint pain and weakness in my elbows, arms has continued to get worse since the 2nd shot left >right. I can't lift things I used to. have pain when grabbing cans off grocery shelves. Vision & lungs have not improved. Need inhaler after 2nd shot

MedDRA releases: 2024-11 · check-in free text available
2022-03-16
Report sent to call center — 12 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 · 1 call case(s)
2022-03-17
Call 1 — Could Not Reach Participant
2022-03-22
Call 2 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-26	Moderna
2	2021-03-16	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-02-17	priority 2/3
2021-03-18	Unsuccessful
2021-04-22	Unsuccessful
2022-03-16	Unsuccessful

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-27

Systemic reaction (other): Shakiness in my right arm (the arm that was injected).

Release 3 — days 1–6 daily, dose 1

2021-01-30

Systemic reaction (other): Palpitations since the day of the shot

Release 3 — day 7, dose 1

2021-02-02

Systemic reaction (other): Ive had intermittent hives/urticaria since the injection.

Release 4 — day 21, dose 1

2021-02-17

Symptoms: I had a miscarriage. I did not know I was pregnant when I took the vaccine

Release 5 — days 1–6 daily, dose 2

2021-03-18

Systemic reaction (other): Arm became weak and I could not move my arm without assistance from other arm by 5pm the day of shot. My rxs were so severe globally that I almost went to the ED. I was dizzy, felt faint, short of breath, severe rxn

Healthcare visit (other): Covid test - negative

Release 6 — days 1–6 daily, dose 2

2021-03-19

Systemic reaction (other): Clammy

2021-03-22

Systemic reaction (other): Yesterday the muscles in my left hand were spasming and it was difficult to drive. My left arm still feels achy and weak. The muscles that tightened up are still super tight.

Release 7 — day 35, dose 2

2021-04-22

Symptoms: I have had vision changes. I cannot read close up. My last appt my doc said I didnt need reading glasses. After severe reaction to 2nd shot I had to increase my font on all devices and cant read at arms length. Also rundown in general. Asthmat

Healthcare visit (other): I will FU with my eye doctor

Release 11 — 12 months, dose 2

2022-03-16

Symptoms: The joint pain and weakness in my elbows, arms has continued to get worse since the 2nd shot left >right. I can't lift things I used to. have pain when grabbing cans off grocery shelves. Vision & lungs have not improved. Need inhaler after 2nd shot 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	SARS-CoV-2 test negative	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Abortion spontaneous	✓	✓	✓
SD	Arthralgia	·	·	✓
SD	Asthma	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Lung disorder	·	·	✓
SD	Muscular weakness	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pregnancy	✓	✓	✓
SD	Visual impairment	✓	✓	✓
SRO	Cold sweat	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Loss of personal independence in daily activities	✓	✓	✓
SRO	Mobility decreased	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓
SRO	Muscle tightness	✓	✓	✓
SRO	Muscular weakness	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Palpitations	✓	✓	✓
SRO	Syncope	○	✓	○
SRO	Tremor	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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