Y6N-27995-09984

1 vaccination 8 coded responses 9 check-ins 8 free-text entries 8 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 554 / MN
Registered: 2021-03-04

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

2021-02-27
Dose 1 — Moderna
2021-03-04
Registered in v-safe
2021-03-04
Survey response — days 1–6 daily, dose 1
MedDRA: Emergency care, Feeling hot, Heart rate increased, Hypersensitivity, Hypertension, Hypoaesthesia, Pain, Pain in extremity, Paraesthesia, Pyrexia, Thirst — Feeling: Poor · Site: Pain · Headache, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, 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: High bp, high beats per minute, pain in calf, pins and needles, numbness, shooting pains, was in ER last 2 nights for allergic reaction, constant thirst, drinking a liter every other hot around the clock, fever up,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
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)
2021-03-05
Survey response — days 1–6 daily, dose 1
MedDRA: Cardiac discomfort, Chest discomfort, Chromatopsia, Tremor — Feeling: Poor · Site: Pain · Joint pains, Muscle or body aches, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Tremors, vision purple spots, lung and heart oressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
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)
2021-03-06
Survey response — day 7, dose 1
MedDRA: Blood pressure increased, Heart rate increased, Night sweats, Oxygen saturation decreased, Tremor — Feeling: Poor · Chills, Headache, Muscle or body aches, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: High bp, high bpm, tremors, severe sweating at night, slight lowered o2

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Report sent to call center — day 7, 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)
2021-03-13
Survey response — day 14, dose 1
MedDRA: Hypertension, Myocardial infarction, Night sweats, Tremor, Urticaria — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Heart attack symptoms, breathing restrictions, full body hives, high bp, intense chest sweating at night, tremors

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Report sent to call center — day 14, 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)
2021-03-20
Survey response — day 21, dose 1
MedDRA: Feeling hot, Injection site reaction, Migraine, Tremor — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Tremors, injection arm heat, injection side migraine, injection arm nerve sensations

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 21, 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)
2021-04-03
Survey response — day 35, dose 1
MedDRA: Chest pain, Dizziness, Nausea, Skin burning sensation, 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 · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Burning skin is back, dizzy, nausea, chest pain · Healthcare visit (other): Lab

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Report sent to call center — day 35, 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)
2021-04-10
Survey response — day 42, dose 1
MedDRA: Vaccine positive rechallenge — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Same as last

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
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)
2021-05-30
Health check-in — 3 months, dose 1
Feeling: Fair

Adult check-in
2021-06-16
Call 1 — Left Voicemail
2021-08-30
Survey response — 6 months, dose 1
MedDRA: Acupuncture, Dystonia, Electric shock sensation, Hypertension, Hypoaesthesia, Mast cell activation syndrome, Pain, Physiotherapy — 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, Hospitalization

Free text: Symptoms: Injection arm complete numbness and shooting electrical pain down arm and involuntary contraction of the entire palm and arm.Mast cell diseaseBeing accessed for POTSHigh bp · Healthcare visit (other): PT, chiro, acupuncture

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-30
Report sent to call center — 6 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-31
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-27	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-04	Unsuccessful
2021-03-05	Unsuccessful
2021-03-06	Unsuccessful
2021-03-13	Unsuccessful
2021-03-20	Unsuccessful
2021-04-03	Unsuccessful
2021-04-10	Unsuccessful
2021-08-30	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-04

Systemic reaction (other): High bp, high beats per minute, pain in calf, pins and needles, numbness, shooting pains, was in ER last 2 nights for allergic reaction, constant thirst, drinking a liter every other hot around the clock, fever up,

2021-03-05

Systemic reaction (other): Tremors, vision purple spots, lung and heart oressure

Release 5 — day 7, dose 1

2021-03-06

Systemic reaction (other): High bp, high bpm, tremors, severe sweating at night, slight lowered o2

Release 5 — day 14, dose 1

2021-03-13

Symptoms: Heart attack symptoms, breathing restrictions, full body hives, high bp, intense chest sweating at night, tremors

Release 6 — day 21, dose 1

2021-03-20

Symptoms: Tremors, injection arm heat, injection side migraine, injection arm nerve sensations

Release 6 — day 35, dose 1

2021-04-03

Symptoms: Burning skin is back, dizzy, nausea, chest pain

Healthcare visit (other): Lab

Release 7 — day 42, dose 1

2021-04-10

Symptoms: Same as last

Release 9 — 6 months, dose 1

2021-08-30

Symptoms: Injection arm complete numbness and shooting electrical pain down arm and involuntary contraction of the entire palm and arm.Mast cell diseaseBeing accessed for POTSHigh bp

Healthcare visit (other): PT, chiro, acupuncture

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	Acupuncture	✓	·	✓
HCVO	Physiotherapy	✓	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dystonia	✓	·	✓
SD	Electric shock sensation	✓	·	✓
SD	Feeling hot	✓	✓	✓
SD	Hypertension	✓	✓	✓
SD	Hypoaesthesia	✓	·	✓
SD	Injection site reaction	✓	✓	✓
SD	Mast cell activation syndrome	✓	·	✓
SD	Migraine	✓	✓	✓
SD	Myocardial infarction	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Night sweats	✓	✓	✓
SD	Pain	✓	·	✓
SD	Skin burning sensation	✓	✓	✓
SD	Tremor	✓	✓	✓
SD	Urticaria	✓	✓	✓
SD	Vaccine positive rechallenge	✓	✓	✓
SRO	Blood pressure increased	✓	✓	✓
SRO	Cardiac discomfort	✓	✓	✓
SRO	Chest discomfort	✓	✓	✓
SRO	Chromatopsia	✓	✓	✓
SRO	Emergency care	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Hypertension	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Night sweats	✓	✓	✓
SRO	Oxygen saturation decreased	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Thirst	✓	✓	✓
SRO	Tremor	✓	✓	✓

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