Y8Q-14501-87002

2 vaccinations 7 coded responses 26 check-ins 7 free-text entries 1 call case

Sex: Female
Age at first dose: 41-45
ZIP prefix: 740 / OK
Registered: 2020-12-29

Relationship: Self
Race: American Indian or Alaska Native
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2020-12-29
Registered in v-safe
2020-12-29
Dose 1 — Moderna
2020-12-29
Survey response — day 0, dose 1
MedDRA: Ear discomfort, Flushing, Pain in jaw — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Facial flush, jaw pain, ear pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-29
Report sent to call center — day 0, dose 1
Be unable to do your normal daily activities

1 call case(s)
2020-12-30
Survey response — days 1–6 daily, dose 1
MedDRA: Insomnia, Nausea — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Mild insomnia last night from nausea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-31
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite — Feeling: Good · Site: Pain · Chills, Joint pains, Muscle or body aches

Free text: Lack of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-01
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite — Feeling: Good · Muscle or body aches, Nausea

Free text: Still lack of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-05
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-15
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-20
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-26
Dose 2 — Moderna
2021-01-26
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Nausea

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-02
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-27
Survey response — 3 months, dose 2
MedDRA: Acne, Brain fog, Ear discomfort, Headache, Rash — Feeling: Good

Free text: Consistent foggy brain, facial breakouts (never ever in life had acne), periodic headaches, ear pressure and sensitivity,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-27
Survey response — 6 months, dose 2
MedDRA: Acne cystic, Body temperature increased, Brain fog, Contusion, Fatigue, Haemorrhage — Feeling: Fair

Free text: Periodicild temp 100.8, brain fog, extreme tiredness, cystic acne(no hormonal imbalance), easy bleeding/bruising(no medication/diet change)

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-01-26
Survey response — 12 months, dose 2
MedDRA: Brain fog, Memory impairment, Rhinorrhoea, Ventricular extrasystoles — Feeling: Fair

Free text: Continuous nasal drip, continuous brain fog/forgetfulness, Continued pvcs

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-29	Moderna
2	2021-01-26	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2020-12-29	priority 2/3

Free text

Release 1 — day 0, dose 1

2020-12-29

Systemic reaction (other): Facial flush, jaw pain, ear pressure

Release 1 — days 1–6 daily, dose 1

2020-12-30

Systemic reaction (other): Mild insomnia last night from nausea

2020-12-31

Systemic reaction (other): Lack of appetite

2021-01-01

Systemic reaction (other): Still lack of appetite

Release 8 — 3 months, dose 2

2021-04-27

Symptoms: Consistent foggy brain, facial breakouts (never ever in life had acne), periodic headaches, ear pressure and sensitivity,

Release 9 — 6 months, dose 2

2021-07-27

Symptoms: Periodicild temp 100.8, brain fog, extreme tiredness, cystic acne(no hormonal imbalance), easy bleeding/bruising(no medication/diet change)

Release 11 — 12 months, dose 2

2022-01-26

Symptoms: Continuous nasal drip, continuous brain fog/forgetfulness, Continued pvcs

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	Acne	✓	✓	✓
SD	Acne cystic	✓	·	✓
SD	Body temperature increased	✓	·	✓
SD	Brain fog	✓	✓	✓
SD	Contusion	✓	·	✓
SD	Ear discomfort	✓	✓	✓
SD	Fatigue	✓	·	✓
SD	Haemorrhage	✓	·	✓
SD	Headache	✓	✓	✓
SD	Memory impairment	·	·	✓
SD	Rash	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	Ventricular extrasystoles	·	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Ear discomfort	✓	✓	✓
SRO	Ear pruritus	○	○	○
SRO	Flushing	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Pain in jaw	✓	✓	✓

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