XVP-18753-72658

3 vaccinations 14 coded responses 39 check-ins 14 free-text entries 6 call cases

Sex: —
Age at first dose: 51-55
ZIP prefix: 240 / VA
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
2021-01-14
Dose 1 — Moderna
2021-01-14
Survey response — 0 day, dose 1
MedDRA: Paraesthesia — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Mouth ulceration — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-01-15
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Chills, Headache

Adult check-in
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain — Feeling: Good · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Blood urine present — Feeling: Good · Site: Pain · Fever · Chills, Abdominal pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-01-21
Survey response — 7 day, dose 1
MedDRA: Tinnitus — Feeling: Fair · Chills, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-01-28
Survey response — 14 day, dose 1
MedDRA: Dizziness, Vitreous floaters — Feeling: Fair

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-05
Survey response — 21 day, dose 1
MedDRA: Fatigue, Hypersomnia — Feeling: Fair · Be unable to work

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-11
Dose 2 — Moderna
2021-02-11
Health check-in — 0 day, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Nausea

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

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

Adult check-in
2021-02-18
Health check-in — 7 day, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — 14 day, dose 2
Feeling: Good

Adult check-in
2021-03-04
Survey response — 21 day, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to work

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-11
Health check-in — 28 day, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — 35 day, dose 2
Feeling: Good

Adult check-in
2021-03-25
Survey response — 42 day, dose 2
MedDRA: Fatigue, Pain — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-05-13
Survey response — 3 month, dose 2
MedDRA: Pre-existing disease, Psoriatic arthropathy, Specialist consultation — Feeling: Good · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-05-13
Report sent to call center — 3 month, 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)
2021-06-14
Call successful
Participant prefers to complete VAERS report online
2021-08-14
Survey response — 6 month, dose 2
MedDRA: Adverse reaction, Brain stem stroke — 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 · Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-14
Report sent to call center — 6 month, 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)
2021-08-18
Call 1 — Left Voicemail
2021-08-29
Dose 3 — Moderna
2021-08-29
Health check-in — 0 day, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-08-30
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school

Adult check-in
2021-08-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-09-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-09-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-09-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-09-05
Health check-in — 7 day, dose 3
Feeling: Good · None

Adult check-in
2021-09-12
Health check-in — 14 day, dose 3
Feeling: Fair

Adult check-in
2021-09-19
Survey response — 21 day, dose 3
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Poor · 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 · check-in answers available
2021-09-19
Report sent to call center — 21 day, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-22
Call 2 — Left Voicemail
2021-09-26
Health check-in — 28 day, dose 3
Feeling: Good

Adult check-in
2021-10-03
Health check-in — 35 day, dose 3
Feeling: Good

Adult check-in
2021-10-10
Health check-in — 42 day, dose 3
Feeling: Good

Adult check-in
2021-11-28
Survey response — 3 month, dose 3
MedDRA: Influenza — 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 · check-in answers available
2021-11-28
Report sent to call center — 3 month, dose 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)
2021-11-30
Call 2 — Left Voicemail
2022-02-27
Health check-in — 6 month, dose 3
Feeling: Good

Adult check-in
2022-08-29
Survey response — 12 month, dose 3
MedDRA: Pre-existing disease, Psoriatic arthropathy — Feeling: Poor · 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 · check-in answers available
2022-08-29
Report sent to call center — 12 month, 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)
2022-08-30
Call 2 — Left Voicemail
2022-08-30
Call 1 — Left Voicemail
2022-08-30
Call 1 — Left Voicemail
2022-08-30
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-11	Moderna
3	2021-08-29	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-15	priority 2/3
2021-05-13	Successful 2021-06-14	Participant prefers to complete VAERS report online
2021-08-14	Unsuccessful
2021-09-19	Unsuccessful
2021-11-28	Unsuccessful
2022-08-29	Unsuccessful

Free text

Release 1

Systemic reaction (other): Tingling in my feet and legs that comes and goes

Release 2

Systemic reaction (other): Mouth ulcers

Systemic reaction (other): Sore throat

Systemic reaction (other): Dont know if this has anything to do with my vaccine, but I had quite a bit of blood in my urine this afternoon.

Systemic reaction (other): Ringing in my ears

Release 3

Symptoms: Dizziness and eye floaters - its subtle but attention getting. Started about a week ago and has been decreasing.

Symptoms: For one afternoon and the following day I had fatigue that knocked me out. I slept for almost 20 hours. The next day I felt completely normal. I take Tremfya and wondered if it has affected the vaccine.

Release 5

Symptoms: Extreme fatigue

Release 6

Symptoms: Body aches and fatigue

Release 8

Symptoms: Psoriatic arthritis flair

Healthcare visit (other): Appointment with rheumatologist

Release 9

Symptoms: Diagnosed with a brain stem stroke until the brain scan came back clear, thankfully. Not sure, but it was most likely an adverse reaction to Tremfya - a biologic I had started 6 months earlier.

Symptoms: Pericarditis came back

Release 10

Symptoms: Flu

Release 12

Symptoms: Having a psoriatic arthritis flare

Free-text releases are not linked to a specific 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	Specialist consultation	✓	✓	✓
SD	Adverse reaction	✓	·	✓
SD	Brain stem stroke	✓	·	✓
SD	Condition aggravated	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Hypersomnia	✓	✓	✓
SD	Influenza	·	·	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Psoriatic arthropathy	✓	✓	✓
SD	Vitreous floaters	✓	✓	✓
SRO	Blood urine present	✓	✓	✓
SRO	Mouth ulceration	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Tinnitus	✓	✓	✓

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