YGL-11966-43641

3 vaccinations 15 coded responses 33 check-ins 15 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 077 / NJ
Registered: 2021-01-18

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

2021-01-18
Registered in v-safe
2021-01-18
Dose 1 — Moderna
2021-01-18
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-08
Survey response — day 21, dose 1
MedDRA: Dry eye, Gastrooesophageal reflux disease — Feeling: Good

Free text: Acid reflux and dry eyes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Dose 2 — Moderna
2021-02-15
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-02-17
Survey response — days 1–6 daily, dose 2
MedDRA: Gastrooesophageal reflux disease — Feeling: Fair · Nausea, Abdominal pain

Free text: Severe reflux

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — days 1–6 daily, dose 2
MedDRA: Gastrooesophageal reflux disease, Oesophageal pain — Feeling: Fair · Nausea

Free text: Reflux, burning in esophagus .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Gastrooesophageal reflux disease — Feeling: Fair · Nausea, Abdominal pain

Free text: Severe reflux

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Gastrooesophageal reflux disease — Feeling: Fair · Nausea, Abdominal pain · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Reflux

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-22
Health check-in — day 7, dose 2
Feeling: Fair · Nausea, Abdominal pain

Adult check-in
2021-03-01
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-15
Survey response — day 28, dose 2
MedDRA: Gastric pH decreased, Ophthalmic migraine — Feeling: Fair

Free text: Continued stomach issues and optical migraines .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — day 35, dose 2
MedDRA: Abdominal pain upper, Nausea — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Severe nausea and stomach pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-29
Survey response — day 42, dose 2
MedDRA: Abdominal pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Severe abdominal pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-17
Survey response — 3 months, dose 2
MedDRA: Gastrointestinal disorder, Ophthalmic migraine — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Occular migraines and abdominal motility issues.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-17
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-16
Call 1 — Could Not Reach Participant
2021-06-21
Call 2 — Left Voicemail
2021-08-16
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-11-08
Dose 3 — Moderna
2021-11-08
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-11-10
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Abdominal pain

Adult check-in
2021-11-12
Survey response — days 1–6 daily, dose 3
MedDRA: Eye irritation, Oral discomfort, Tongue discomfort — Feeling: Fair

Free text: Burning sensation in eyes, lips, tongue and palate.

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Survey response — days 1–6 daily, dose 3
MedDRA: Gingival bleeding, Oral discomfort, Tongue discomfort — Feeling: Fair

Free text: Burning sensation on lips, tongue and palate. Heavily bleeding gums .

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Survey response — day 7, dose 3
MedDRA: Dry eye, Eye irritation, Oral discomfort, Tongue discomfort — Feeling: Fair

Free text: Burning sensation on lips, tongue, palate ( ongoing for 5 days) and dry and burning eyes.

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-29
Survey response — day 21, dose 3
MedDRA: Abdominal pain — Feeling: Fair

Free text: Abdominal pain

MedDRA releases: 2024-11 · check-in free text available
2021-12-01
Call 1 — Left Voicemail
2021-12-02
Call 3 — Requested Callback
2021-12-02
Callback requested for
12:30PM ET
2021-12-02
Call successful
Participant prefers to complete VAERS report online
2021-12-06
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-15
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-22
Survey response — day 42, dose 3
MedDRA: Abdominal discomfort, Gastrooesophageal reflux disease, Ophthalmic migraine — Feeling: Fair

Free text: Increased acid reflux and abdominal discomfort. Occular migraines

MedDRA releases: 2024-11 · check-in free text available
2022-02-09
Survey response — 3 months, dose 3
MedDRA: Abdominal discomfort, Gastrooesophageal reflux disease — Feeling: Fair

Free text: Increased reflux and abdominal discomfort.

MedDRA releases: 2024-11 · check-in free text available
2022-05-12
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-18	Moderna
2	2021-02-15	Moderna
3	2021-11-08	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-20	Successful	Participant prefers to complete VAERS report online
2021-03-22	Successful	Participant prefers to complete VAERS report online
2021-03-29	Successful	Participant prefers to complete VAERS report online
2021-05-17	Successful 2021-12-02	Participant prefers to complete VAERS report online

Free text

Release 3 — day 21, dose 1

2021-02-08

Symptoms: Acid reflux and dry eyes

Release 4 — days 1–6 daily, dose 2

2021-02-17

Systemic reaction (other): Severe reflux

2021-02-18

Systemic reaction (other): Reflux, burning in esophagus .

2021-02-19

Systemic reaction (other): Severe reflux

2021-02-20

Systemic reaction (other): Reflux

Release 5 — day 28, dose 2

2021-03-15

Symptoms: Continued stomach issues and optical migraines .

Release 6 — day 35, dose 2

2021-03-22

Symptoms: Severe nausea and stomach pain

Release 6 — day 42, dose 2

2021-03-29

Symptoms: Severe abdominal pain

Release 8 — 3 months, dose 2

2021-05-17

Symptoms: Occular migraines and abdominal motility issues.

Release 10 — days 1–6 daily, dose 3

2021-11-12

Systemic reaction (other): Burning sensation in eyes, lips, tongue and palate.

2021-11-13

Systemic reaction (other): Burning sensation on lips, tongue and palate. Heavily bleeding gums .

Release 10 — day 7, dose 3

2021-11-15

Systemic reaction (other): Burning sensation on lips, tongue, palate ( ongoing for 5 days) and dry and burning eyes.

Release 10 — day 21, dose 3

2021-11-29

Symptoms: Abdominal pain

Release 10 — day 42, dose 3

2021-12-22

Symptoms: Increased acid reflux and abdominal discomfort. Occular migraines

Release 11 — 3 months, dose 3

2022-02-09

Symptoms: Increased reflux and abdominal discomfort.

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	Abdominal discomfort	·	·	✓
SD	Abdominal pain	✓	✓	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Dry eye	✓	✓	✓
SD	Gastric pH decreased	✓	✓	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Gastrooesophageal reflux disease	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Ophthalmic migraine	✓	✓	✓
SRO	Dry eye	·	·	✓
SRO	Eye irritation	·	·	✓
SRO	Gastrooesophageal reflux disease	✓	✓	✓
SRO	Gingival bleeding	·	·	✓
SRO	Oesophageal pain	✓	✓	✓
SRO	Oral discomfort	·	·	✓
SRO	Tongue discomfort	·	·	✓

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