Y7M-16039-37995

3 vaccinations 14 coded responses 32 check-ins 14 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 945 / CA
Registered: 2021-01-30

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

2021-01-28
Dose 1 — Moderna
2021-01-30
Registered in v-safe
2021-01-30
Survey response — days 1–6 daily, dose 1
MedDRA: Head discomfort — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Facial pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Survey response — days 1–6 daily, dose 1
MedDRA: Head discomfort, Rhinorrhoea, Sneezing, Throat irritation — Feeling: Fair · Fever · Chills · Be unable to do your normal daily activities

Free text: Sneezing all day, nose running, itchy throat, head pressure,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

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

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-18
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-25
Dose 2 — Moderna
2021-02-25
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · 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
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Dizziness — Feeling: Fair · Site: Pain, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Dizziness, balance issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Dizziness — Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizzy/balance off

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Dizziness — Feeling: Fair · Site: Swelling · Fatigue or tiredness

Free text: Dizzy/balance

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — day 7, dose 2
MedDRA: Dizziness — Feeling: Good · Fatigue or tiredness

Free text: Mild dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-27
Survey response — 3 months, dose 2
MedDRA: Blood test abnormal, C-reactive protein increased, Office visit — 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: Symptoms: Had a CRVO in left eye.Also C Reactive Protein in blood is high.Other blood work was high as well. · Healthcare visit (other): Retina specialist visit.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-26
Survey response — 6 months, dose 2
MedDRA: C-reactive protein increased, Retinal vein occlusion — Feeling: Fair · 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: Branch retinal vein occlusion left eye. C Reactive Protein high in blood..heart risk.Mixed cholesterol results.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-26
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-31
Call 1 — Left Voicemail
2021-10-31
Dose 3 — Moderna
2021-11-08
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-14
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-21
Survey response — day 21, dose 3
MedDRA: Gastrointestinal disorder — Feeling: Fair

Free text: Stomach and intestinal issues.

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-05
Survey response — day 35, dose 3
MedDRA: Body temperature increased, Chills, Head discomfort, Malaise, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activities

Free text: Sick with fever 99.7 f 11/30 and 12/1. Chills and head pressure. No congestion. Took Binax Covid antigen at home test. Negative results on 12/ 1.

MedDRA releases: 2024-11 · check-in free text available
2021-12-12
Survey response — day 42, dose 3
MedDRA: Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities

Free text: Brvo right eye AntiVEGF shots to eye not working.

MedDRA releases: 2024-11 · check-in free text available
2022-01-30
Survey response — 3 months, dose 3
MedDRA: Arthralgia — Feeling: Fair

Free text: Shoulder pain left side

MedDRA releases: 2024-11 · check-in free text available
2022-05-03
Survey response — 6 months, dose 3
MedDRA: Headache, Musculoskeletal stiffness, Urinary tract infection — 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: UTI Headaches Neck stiff

MedDRA releases: 2024-11 · check-in free text available
2022-05-03
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-04
Call 1 — Left Voicemail
2022-05-04
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-31
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-28	Moderna
2	2021-02-25	Moderna
3	2021-10-31	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-05-27	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-08-26	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-03	Successful 2022-05-04	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 3 — days 1–6 daily, dose 1

2021-01-30

Systemic reaction (other): Facial pressure

2021-01-31

Systemic reaction (other): Sneezing all day, nose running, itchy throat, head pressure,

Release 4 — days 1–6 daily, dose 2

2021-02-28

Systemic reaction (other): Dizziness, balance issues

2021-03-01

Systemic reaction (other): Dizzy

2021-03-02

Systemic reaction (other): Dizzy/balance off

Release 5 — days 1–6 daily, dose 2

2021-03-03

Systemic reaction (other): Dizzy/balance

Release 5 — day 7, dose 2

2021-03-04

Systemic reaction (other): Mild dizzy

Release 8 — 3 months, dose 2

2021-05-27

Symptoms: Had a CRVO in left eye.Also C Reactive Protein in blood is high.Other blood work was high as well.

Healthcare visit (other): Retina specialist visit.

Release 9 — 6 months, dose 2

2021-08-26

Symptoms: Branch retinal vein occlusion left eye. C Reactive Protein high in blood..heart risk.Mixed cholesterol results.

Release 10 — day 21, dose 3

2021-11-21

Symptoms: Stomach and intestinal issues.

Release 10 — day 35, dose 3

2021-12-05

Symptoms: Sick with fever 99.7 f 11/30 and 12/1. Chills and head pressure. No congestion. Took Binax Covid antigen at home test. Negative results on 12/ 1.

Release 10 — day 42, dose 3

2021-12-12

Symptoms: Brvo right eye AntiVEGF shots to eye not working.

Release 11 — 3 months, dose 3

2022-01-30

Symptoms: Shoulder pain left side

Release 11 — 6 months, dose 3

2022-05-03

Symptoms: UTI Headaches Neck stiff

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	✓	✓	✓
SD	Arthralgia	·	·	✓
SD	Blood test abnormal	✓	✓	✓
SD	Body temperature increased	·	·	✓
SD	C-reactive protein increased	✓	✓	✓
SD	Chills	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Head discomfort	·	·	✓
SD	Headache	·	·	✓
SD	Malaise	·	·	✓
SD	Musculoskeletal stiffness	·	·	✓
SD	Retinal vein occlusion	✓	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Urinary tract infection	·	·	✓
SRO	Balance disorder	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Head discomfort	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sneezing	✓	✓	✓
SRO	Throat irritation	✓	✓	✓

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