XXX-17753-62861

2 vaccinations 3 coded responses 27 check-ins 3 free-text entries 2 call cases

Sex: Female
Age at first dose: 21-25
ZIP prefix: 774 / TX
Registered: 2021-01-04

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

2021-01-04
Registered in v-safe
2021-01-04
Dose 1 — Moderna
2021-01-04
Health check-in — 0 day, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-01-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Swelling · Fever · Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-11
Health check-in — 7 day, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — 14 day, dose 1
Feeling: Good

Adult check-in
2021-01-25
Health check-in — 21 day, dose 1
Feeling: Good

Adult check-in
2021-02-01
Health check-in — 28 day, dose 1
Feeling: Good

Adult check-in
2021-02-02
Dose 2 — Moderna
2021-02-02
Survey response — 0 day, dose 2
MedDRA: Blindness, Blood pressure decreased, Immediate post-injection reaction, Syncope — Feeling: Poor · Site: Pain, Swelling · Chills, Headache, Fatigue or tiredness, Nausea, Vomiting · Be unable to work, Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-03
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — 7 day, dose 2
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — 14 day, dose 2
Feeling: Good

Adult check-in
2021-02-23
Health check-in — 21 day, dose 2
Feeling: Good

Adult check-in
2021-03-02
Health check-in — 28 day, dose 2
Feeling: Good

Adult check-in
2021-03-09
Health check-in — 35 day, dose 2
Feeling: Good

Adult check-in
2021-03-16
Health check-in — 42 day, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — 3 month, dose 2
Feeling: Good

Adult check-in
2021-08-05
Survey response — 6 month, dose 2
MedDRA: Dry eye, Hypoaesthesia, Pain in extremity — 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

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-05
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)
2021-11-03
Call 1 — Left Voicemail
2021-11-08
Call successful
Does not wish to fill out VAERS report
2022-02-02
Survey response — 12 month, dose 2
MedDRA: Blepharospasm, Dysaesthesia, Dyspnoea, Formication, Hypoaesthesia, Neurological symptom, Paraesthesia — 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

MedDRA releases: 2024-11 · check-in answers available
2022-02-02
Report sent to call center — 12 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

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-02-04
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-02-02	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-08-05	Successful 2021-11-08	Does not wish to fill out VAERS report
2022-02-02	Unsuccessful

Free text

Release 3

Systemic reaction (other): 5 minutes after injection almost fainted, lost vision for several minutes, very low BP

Release 9

Symptoms: Rapid onset of Dry eye syndrome starting April 2021. Also currently being treated for possible sciatic nerve issue or possible auto-immune disorder due to left leg pain/numbness

Release 11

Symptoms: Numbness/tingling in arms/legs/hands/feet, neurological symptoms such as dysesthesia/skin crawling, eye twitching, unable to take full satisfying breaths every time

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
SD	Blepharospasm	·	·	✓
SD	Dry eye	✓	·	✓
SD	Dysaesthesia	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Formication	·	·	✓
SD	Hypoaesthesia	✓	·	✓
SD	Neurological symptom	·	·	✓
SD	Pain in extremity	✓	·	✓
SD	Paraesthesia	·	·	✓
SRO	Blindness	✓	✓	✓
SRO	Blood pressure decreased	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Syncope	✓	✓	✓

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