Y6E-11698-90871

2 vaccinations 8 coded responses 14 check-ins 8 free-text entries 5 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 060 / CT
Registered: 2021-05-08

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

2021-04-09
Dose 1 — Moderna
2021-05-07
Dose 2 — Moderna
2021-05-08
Registered in v-safe
2021-05-08
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-05-10
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in extremity — Feeling: Good · Site: Pain

Free text: legs have hurt since vax more

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache · Be unable to do your normal daily activities

Adult check-in
2021-05-13
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in extremity — Feeling: Good · Site: Itching

Free text: Leg still hurts

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-23
Survey response — day 14, dose 2
MedDRA: Pain in extremity, Ultrasound scan — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: leg hurts...got ultrasound for clots. following up this week as my leg still hurts · Healthcare visit (other): ultrasound

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-28
Survey response — day 21, dose 2
MedDRA: Superficial vein thrombosis — Feeling: Fair · 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: Superficial Vein Thrombosis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-28
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-04
Survey response — day 28, dose 2
MedDRA: Thrombosis, Unevaluable event — 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

Free text: Symptoms: I have been diagnosed with a blood clot in my leg · Healthcare visit (other): ultraounds

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-11
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-06-18
Survey response — day 42, dose 2
MedDRA: Pain in extremity, Thrombosis — Feeling: Poor · Be unable to do your normal daily activities

Free text: leg hurts bad from thrombosis, I just don't feel right

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-06
Survey response — 3 months, dose 2
MedDRA: Lymphadenopathy, Malaise, Mobility decreased, Thrombosis — 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, Emergency room or emergency department visit

Free text: Besides blood clot in my leg, I still have little movement in my arm after 3 months, lymph nodes are always up and over all malaise since the vaccine.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-06
Report sent to call center — 3 months, 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)
2021-08-16
Call successful
Other
2021-11-05
Survey response — 6 months, dose 2
MedDRA: Superficial vein thrombosis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: superficial vein thrombosis still present

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
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

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
2021-11-08
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-09	Moderna
2	2021-05-07	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-05-23	Successful	Other
2021-05-28	Successful	Other
2021-06-04	Successful	Other
2021-08-06	Successful 2021-08-16	Other
2021-11-05	Successful 2021-11-08	Participant prefers to complete VAERS report online

Free text

Release 8 — days 1–6 daily, dose 2

2021-05-10

Systemic reaction (other): legs have hurt since vax more

2021-05-13

Systemic reaction (other): Leg still hurts

Release 8 — day 14, dose 2

2021-05-23

Symptoms: leg hurts...got ultrasound for clots. following up this week as my leg still hurts

Healthcare visit (other): ultrasound

Release 8 — day 21, dose 2

2021-05-28

Symptoms: Superficial Vein Thrombosis

Release 8 — day 28, dose 2

2021-06-04

Symptoms: I have been diagnosed with a blood clot in my leg

Healthcare visit (other): ultraounds

Release 9 — day 42, dose 2

2021-06-18

Symptoms: leg hurts bad from thrombosis, I just don't feel right

Release 9 — 3 months, dose 2

2021-08-06

Symptoms: Besides blood clot in my leg, I still have little movement in my arm after 3 months, lymph nodes are always up and over all malaise since the vaccine.

Release 10 — 6 months, dose 2

2021-11-05

Symptoms: superficial vein thrombosis still present

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	Ultrasound scan	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Lymphadenopathy	✓	·	✓
SD	Malaise	✓	·	✓
SD	Mobility decreased	✓	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Superficial vein thrombosis	✓	✓	✓
SD	Thrombosis	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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