Y8P-15825-77882

4 vaccinations 11 coded responses 22 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 936 / CA
Registered: 2021-01-14

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

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Survey response — day 0, dose 1
MedDRA: Headache, Pre-existing disease — Feeling: Good · Fever · Headache

Free text: I did have a slight headache that started at the place. I got the injection. t it is gone.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Dysphonia — Feeling: Good

Free text: Not sure, but my voice was hoarse for 3 days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Survey response — day 7, dose 1
MedDRA: Nasal congestion, Sinus pain — Feeling: Good

Free text: Just a stuffy nose sinus pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Survey response — day 14, dose 1
MedDRA: Pain in extremity, Pre-existing disease, Psoriatic arthropathy, Skin exfoliation — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: The tips of my fingers are perling and digital psiratic arthritis with increased soreness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-06
Survey response — day 21, dose 1
MedDRA: Erythema, Eye pain, Ocular hyperaemia, Skin discolouration, Skin lesion — Feeling: Good

Free text: Finger tips, red, purple and small red lesions. Eyes whites red and sore.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Dose 2 — Moderna
2021-02-11
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Nausea

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Body temperature increased, Eye irritation, Skin burning sensation — Feeling: Fair · Site: Pain · Fever · Nausea

Free text: My eyes burn, nose area between my eyes. My normal temp is 96.7 do 98.0 would be high for me.mal

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness, Nausea

Adult check-in
2021-02-17
Survey response — days 1–6 daily, dose 2
MedDRA: Vision blurred — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: Vision a lityle blurry. Hard to see writing or number ver well. s

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — day 7, dose 2
MedDRA: Eye pain, Pain in extremity, Retching, Vision blurred — Feeling: Fair · Muscle or body aches, Nausea

Free text: Dry heaves, eye pain, blury vision close up leg aches.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — day 14, dose 2
MedDRA: Back injury, Chest injury, Eye pain, Fall, Spinal cord injury — Feeling: Fair

Free text: I fell and injured my back ribs, spine. Not connected with COVID. Not skerpling well. Still have pain in my eyes.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-11
Survey response — day 28, dose 2
MedDRA: Eye pain, Scleral discolouration, Vision blurred — Feeling: Fair

Free text: Pain in eyes little blury and red sclera.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-16
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-05-24
Call 1 — Left Voicemail
2021-08-12
Survey response — 6 months, dose 2
MedDRA: Fatigue, Muscle spasms, Smoke sensitivity, Vision blurred, Visual impairment — Feeling: Fair · Be unable to do your normal daily activities

Free text: Lower legs cramping, visual changes, fluctuates in clarity, fatigue, nothing major I guess. Its hard to telm, as there has been air quality issues due to smoke from fires on and off. Plus I deal with other med issues also. I'm still moving so they

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-01
Dose 3 — Moderna
2022-05-23
Dose 4 — Moderna
2022-11-23
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-11	Moderna
3	2021-11-01	Moderna	No
4	2022-05-23	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-29	Unsuccessful

Free text

Release 2 — day 0, dose 1

2021-01-14

Systemic reaction (other): I did have a slight headache that started at the place. I got the injection. t it is gone.

Release 2 — days 1–6 daily, dose 1

2021-01-19

Systemic reaction (other): Not sure, but my voice was hoarse for 3 days.

Release 2 — day 7, dose 1

2021-01-21

Systemic reaction (other): Just a stuffy nose sinus pain

Release 3 — day 14, dose 1

2021-01-29

Symptoms: The tips of my fingers are perling and digital psiratic arthritis with increased soreness.

Release 3 — day 21, dose 1

2021-02-06

Symptoms: Finger tips, red, purple and small red lesions. Eyes whites red and sore.

Release 4 — days 1–6 daily, dose 2

2021-02-15

Systemic reaction (other): My eyes burn, nose area between my eyes. My normal temp is 96.7 do 98.0 would be high for me.mal

2021-02-17

Systemic reaction (other): Vision a lityle blurry. Hard to see writing or number ver well. s

Release 4 — day 7, dose 2

2021-02-18

Systemic reaction (other): Dry heaves, eye pain, blury vision close up leg aches.

Release 4 — day 14, dose 2

2021-02-25

Symptoms: I fell and injured my back ribs, spine. Not connected with COVID. Not skerpling well. Still have pain in my eyes.

Release 5 — day 28, dose 2

2021-03-11

Symptoms: Pain in eyes little blury and red sclera.

Release 9 — 6 months, dose 2

2021-08-12

Symptoms: Lower legs cramping, visual changes, fluctuates in clarity, fatigue, nothing major I guess. Its hard to telm, as there has been air quality issues due to smoke from fires on and off. Plus I deal with other med issues also. I'm still moving so they cut off by CDC

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
SD	Back injury	✓	✓	✓
SD	Chest injury	✓	✓	✓
SD	Erythema	✓	✓	✓
SD	Eye pain	✓	✓	✓
SD	Fall	✓	✓	✓
SD	Fatigue	✓	·	✓
SD	Muscle spasms	✓	·	✓
SD	Ocular hyperaemia	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Psoriatic arthropathy	✓	✓	✓
SD	Scleral discolouration	✓	✓	✓
SD	Skin discolouration	✓	✓	✓
SD	Skin exfoliation	✓	✓	✓
SD	Skin lesion	✓	✓	✓
SD	Smoke sensitivity	✓	·	✓
SD	Spinal cord injury	✓	✓	✓
SD	Vision blurred	✓	✓	✓
SD	Visual impairment	✓	·	✓
SRO	Body temperature increased	✓	✓	✓
SRO	Dysphonia	✓	✓	✓
SRO	Eye irritation	✓	✓	✓
SRO	Eye pain	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Nasal congestion	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Retching	✓	✓	✓
SRO	Sinus pain	✓	✓	✓
SRO	Skin burning sensation	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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