Y6J-17680-18844

1 vaccination 7 coded responses 15 check-ins 7 free-text entries 9 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 424 / KY
Registered: 2021-01-11

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

2021-01-11
Registered in v-safe
2021-01-11
Dose 1 — Moderna
2021-01-11
Survey response — day 0, dose 1
MedDRA: Feeling cold, Tremor — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Nausea

Free text: I can't stop shaking for over an hour, feel like I'm under a blanket of ice

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-12
Survey response — days 1–6 daily, dose 1
MedDRA: Paraesthesia — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Tingling in hands & feet

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-12
Report sent to call center — days 1–6 daily, dose 1
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)
2021-01-13
Survey response — days 1–6 daily, dose 1
MedDRA: Cough — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Coughing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Headache, 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
2021-01-14
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Headache, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-15
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Fair · Fever · Headache, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: If so didnt have covid when I got the vaccine, this would have been different

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Headache, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-17
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-21
Health check-in — day 7, dose 1
Feeling: Fair · Fever · Headache, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-25
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-02-01
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-08
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-15
Health check-in — day 35, dose 1
Feeling: Good

Adult check-in
2021-02-22
Survey response — day 42, dose 1
MedDRA: Arrhythmia, Dizziness, Dyspnoea, Hypotension, Tachycardia, Unevaluable event — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Severe arrhythmia & tachycardia- going to the dr in the morning. Severe shortness of breath & very dizzy. Blood pressure is very low · Healthcare visit (other): Going to my primary in the morning

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Report sent to call center — day 42, dose 1
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)
2021-03-02
Call 1 — Left Voicemail
2021-03-11
Call 2 — Left Voicemail
2021-04-12
Survey response — 3 months, dose 1
MedDRA: Blood pressure increased, Dizziness, Fatigue, Heart rate increased, Office visit, Palpitations — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Severe heart palpitations, elevated heart rate, blood pressure spikes, dizziness and still severely fatigued · Healthcare visit (other): Electrophysiologist, Pulmonologist, Family Dr and my Nurse Practitioner

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Report sent to call center — 3 months, dose 1
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)
2021-07-12
Survey response — 6 months, dose 1
MedDRA: Electrocardiogram abnormal, Heart rate increased, Hypertension, Intensive care — 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 · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization

Free text: Ended up in ICU w/severe heart rates between 150-180bpm and high blood pressure. My Cardiologist & Primary are working to find the right dosages of meds. Stamina has gone backwards. EKG shows a Septal Infarcta

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-12
Report sent to call center — 6 months, 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)
2021-07-29
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-11	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-12	Unsuccessful
2021-01-13	Unsuccessful
2021-01-14	Unsuccessful
2021-01-15	Unsuccessful
2021-01-16	Unsuccessful
2021-01-17	Unsuccessful
2021-02-22	Unsuccessful
2021-04-12	Unsuccessful
2021-07-12	Unsuccessful

Free text

Release 1 — day 0, dose 1

2021-01-11

Systemic reaction (other): I can't stop shaking for over an hour, feel like I'm under a blanket of ice

Release 1 — days 1–6 daily, dose 1

2021-01-12

Systemic reaction (other): Tingling in hands & feet

2021-01-13

Systemic reaction (other): Coughing

Release 2 — days 1–6 daily, dose 1

2021-01-16

Systemic reaction (other): If so didnt have covid when I got the vaccine, this would have been different

Release 4 — day 42, dose 1

2021-02-22

Symptoms: Severe arrhythmia & tachycardia- going to the dr in the morning. Severe shortness of breath & very dizzy. Blood pressure is very low

Healthcare visit (other): Going to my primary in the morning

Release 7 — 3 months, dose 1

2021-04-12

Symptoms: Severe heart palpitations, elevated heart rate, blood pressure spikes, dizziness and still severely fatigued

Healthcare visit (other): Electrophysiologist, Pulmonologist, Family Dr and my Nurse Practitioner

Release 9 — 6 months, dose 1

2021-07-12

Symptoms: Ended up in ICU w/severe heart rates between 150-180bpm and high blood pressure. My Cardiologist & Primary are working to find the right dosages of meds. Stamina has gone backwards. EKG shows a Septal Infarcta

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	Office visit	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Arrhythmia	✓	✓	✓
SD	Arthritis bacterial	○	○	○
SD	Blood pressure increased	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Electrocardiogram abnormal	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Heart rate increased	✓	✓	✓
SD	Hypertension	✓	✓	✓
SD	Hypotension	✓	✓	✓
SD	Intensive care	✓	✓	✓
SD	Palpitations	✓	✓	✓
SD	Tachycardia	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Feeling cold	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Tremor	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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