XWA-35243-94614

2 vaccinations 12 coded responses 18 check-ins 12 free-text entries 2 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 975 / OR
Registered: 2021-08-07

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

2021-07-30
Dose 1 — Moderna
2021-08-07
Registered in v-safe
2021-08-07
Survey response — 7 day, dose 1
MedDRA: Adverse reaction, Immediate post-injection reaction — Feeling: Fair · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-13
Survey response — 14 day, dose 1
MedDRA: Headache, Inflammation, Mobility decreased, Musculoskeletal stiffness, Pain, Self-medication, Sleep disorder — 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: 2021-09,2024-11 · check-in answers available
2021-08-13
Report sent to call center — 14 day, dose 1
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)
2021-08-20
Call 1 — Left Voicemail
2021-08-22
Survey response — 21 day, dose 1
MedDRA: Blood blister, Headache, Injection site pain, Musculoskeletal stiffness, Pruritus — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-27
Health check-in — 28 day, dose 1
Feeling: Good

Adult check-in
2021-08-30
Dose 2 — Moderna
2021-08-30
Survey response — 0 day, dose 2
MedDRA: Arthralgia, Euphoric mood, Feeling abnormal, Immediate post-injection reaction, Neck pain, Otitis externa, Pain, Pruritus — Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-31
Survey response — days 1–6 daily, dose 2
MedDRA: Altered visual depth perception — Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-09-01
Survey response — days 1–6 daily, dose 2
MedDRA: Aphasia, Brain fog — Feeling: Fair · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-09-02
Survey response — days 1–6 daily, dose 2
MedDRA: Uterine spasm — Feeling: Fair · Site: Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-09-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-04
Survey response — days 1–6 daily, dose 2
MedDRA: Insomnia — Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-09-05
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Pain in extremity — Feeling: Good · Joint pains, Muscle or body aches

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-09-07
Health check-in — 7 day, dose 2
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-13
Survey response — 14 day, dose 2
MedDRA: Bladder disorder, Cholelithiasis, Office visit, Uterine pain — 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 · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11 · check-in answers available
2021-09-13
Report sent to call center — 14 day, 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)
2021-09-16
Call 1 — Left Voicemail
2021-09-22
Health check-in — 21 day, dose 2
Feeling: Fair

Adult check-in
2021-09-27
Survey response — 28 day, dose 2
MedDRA: Muscle spasms, Ovarian enlargement — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2021-10-06
Health check-in — 35 day, dose 2
Feeling: Fair

Adult check-in
2021-11-29
Survey response — 3 month, dose 2
MedDRA: Gallbladder disorder — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-09-01
Health check-in — 12 month, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-07-30	Moderna	No
2	2021-08-30	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-08-13	Unsuccessful
2021-09-13	Unsuccessful

Free text

Release 9

Systemic reaction (other): Symptoms started 25 minutes after injection and remain today

Symptoms: Increasing headache, lack of mobility in neck and upper back area. Unable to sleep due to pain. Stiffness and inflamation continue. Otc meds lesson it but wont get rid of it. Called doctor. Going in next week if symptoms persist.

Symptoms: New pain in the injection siteWrist itcging has increasedAt last checkin forgot to mention blood blister on arm- has since faded- not sure if related or not. Have never had one prior. Stiffness in neck and back still continues. Headache subsided

Systemic reaction (other): Neck pain again started about 3 minutes after injection. With 8 minutes very mentally fuzzy. Feels like a pain narcotic high, joint pain in both hands, hip pain on side of infection, mild swimmers ear sensation, itching on foreaems again. Had 2hr ago cut off by CDC

Systemic reaction (other): Depth perception off.

Systemic reaction (other): Lots of mental fuzziness. Hard to verbalize the words the words I want to say.

Systemic reaction (other): Something I had forgotten to mention begining the night of getting 2nd shot I've had strong cramps in uterus area- only at night

Systemic reaction (other): Have had difficulty sleeping the last 3 nights

Systemic reaction (other): Pain in ankles and lower legs

Symptoms: Gallstones, uteran pain, bladder issues

Healthcare visit (other): 2 visits to urgent care

Symptoms: Continued on and off ceamping in ovary area where the enlarged ivary was found.

Release 10

Symptoms: Continued gallbladder attacks

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	Office visit	·	·	✓
SD	Bladder disorder	·	·	✓
SD	Blood blister	✓	·	✓
SD	Cholelithiasis	·	·	✓
SD	Gallbladder disorder	·	·	✓
SD	Headache	✓	·	✓
SD	Inflammation	✓	·	✓
SD	Injection site pain	✓	·	✓
SD	Mobility decreased	✓	·	✓
SD	Muscle spasms	·	·	✓
SD	Musculoskeletal stiffness	✓	·	✓
SD	Ovarian enlargement	·	·	✓
SD	Pain	✓	·	✓
SD	Pruritus	✓	·	✓
SD	Self-medication	✓	·	✓
SD	Sleep disorder	✓	·	✓
SD	Uterine pain	·	·	✓
SRO	Adverse reaction	✓	·	✓
SRO	Altered visual depth perception	✓	·	✓
SRO	Aphasia	✓	·	✓
SRO	Arthralgia	✓	·	✓
SRO	Brain fog	✓	·	✓
SRO	Euphoric mood	✓	·	✓
SRO	Feeling abnormal	✓	·	✓
SRO	Immediate post-injection reaction	✓	·	✓
SRO	Insomnia	✓	·	✓
SRO	Neck pain	✓	·	✓
SRO	Otitis externa	✓	·	✓
SRO	Pain	✓	·	✓
SRO	Pain in extremity	✓	·	✓
SRO	Pruritus	✓	·	✓
SRO	Uterine spasm	✓	·	✓

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