YRY-17332-90964

3 vaccinations 11 coded responses 31 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 46-50
ZIP prefix: 945 / CA
Registered: 2021-03-25

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Registered dependents

CBQ-19419-75358 Child or adolescent in my care · Male · 2021-11-13

W67-25448-87842 Child or adolescent in my care · Male · 2021-11-13

Timeline

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

2021-03-25
Registered in v-safe
2021-03-25
Dose 1 — Moderna
2021-03-25
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Good

Free text: No but I took 2 aleve before the shot to help with symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — days 1–6 daily, dose 1
MedDRA: Self-medication — Feeling: Good · Site: Pain · Fever

Free text: Taking aleve every 12 hrs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Survey response — days 1–6 daily, dose 1
MedDRA: Nasal dryness, Rash, Rhinalgia — Feeling: Good · Site: Pain · Fever

Free text: Small rash on right cheek & really dry nose left nostril where it hurt some to breathe

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-01
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-10
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-21
Dose 2 — Moderna
2021-04-22
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-23
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-25
Survey response — days 1–6 daily, dose 2
MedDRA: Anxiety — Feeling: Good · Site: Pain, Itching

Free text: Feeling anxious since my initial shot and today not sure if its related

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Survey response — days 1–6 daily, dose 2
MedDRA: Blepharospasm — Feeling: Good

Free text: Eye has been twitching intermittently since shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Survey response — day 7, dose 2
MedDRA: Blepharospasm — Feeling: Good

Free text: Lots of eye twitches everyday since

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Survey response — day 21, dose 2
MedDRA: Blepharospasm — Feeling: Good

Free text: Still eye twitching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-26
Survey response — day 35, dose 2
MedDRA: Headache, Nausea, Office visit, Vertigo — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Bad Vertigo, Nausea, Headache -scheduled to see my dr on Friday. · Healthcare visit (other): Office visit 5/28

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-26
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-02
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-21
Survey response — 3 months, dose 2
MedDRA: Heart rate increased, Tachycardia — Feeling: Good · Be unable to do your normal daily activities

Free text: Tachycardia rapid heart rate for a day

MedDRA releases: 2024-11 · check-in free text available
2021-10-22
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-12
Dose 3 — Moderna
Co-administered: Flu
2021-11-13
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Itching · Muscle or body aches

Adult check-in
2021-11-15
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-16
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-17
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-18
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-19
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-26
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-03
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-10
Survey response — day 28, dose 3
MedDRA: Extrasystoles, Palpitations — Feeling: Good

Free text: Heart palpitations or skips in beat

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-24
Survey response — day 42, dose 3
MedDRA: Extrasystoles, Palpitations — Feeling: Good

Free text: Heart palpitations, skipping beats randomly

MedDRA releases: 2024-11 · check-in free text available
2022-02-13
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-12
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-25	Moderna
2	2021-04-21	Moderna
3	2021-11-12	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-05-26	Unsuccessful

Free text

Release 6 — day 0, dose 1

2021-03-25

Systemic reaction (other): No but I took 2 aleve before the shot to help with symptoms

Release 6 — days 1–6 daily, dose 1

2021-03-26

Systemic reaction (other): Taking aleve every 12 hrs

2021-03-27

Systemic reaction (other): Small rash on right cheek & really dry nose left nostril where it hurt some to breathe

Release 7 — days 1–6 daily, dose 2

2021-04-25

Systemic reaction (other): Feeling anxious since my initial shot and today not sure if its related

Release 8 — days 1–6 daily, dose 2

2021-04-26

Systemic reaction (other): Eye has been twitching intermittently since shot

Release 8 — day 7, dose 2

2021-04-30

Systemic reaction (other): Lots of eye twitches everyday since

Release 8 — day 21, dose 2

2021-05-12

Symptoms: Still eye twitching

Release 8 — day 35, dose 2

2021-05-26

Symptoms: Bad Vertigo, Nausea, Headache -scheduled to see my dr on Friday.

Healthcare visit (other): Office visit 5/28

Release 9 — 3 months, dose 2

2021-07-21

Symptoms: Tachycardia rapid heart rate for a day

Release 10 — day 28, dose 3

2021-12-10

Symptoms: Heart palpitations or skips in beat

Release 10 — day 42, dose 3

2021-12-24

Symptoms: Heart palpitations, skipping beats randomly

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	Blepharospasm	✓	✓	✓
SD	Extrasystoles	·	·	✓
SD	Headache	✓	✓	✓
SD	Heart rate increased	·	·	✓
SD	Nausea	✓	✓	✓
SD	Palpitations	·	·	✓
SD	Tachycardia	·	·	✓
SD	Vertigo	✓	✓	✓
SRO	Anxiety	✓	✓	✓
SRO	Blepharospasm	✓	✓	✓
SRO	Nasal dryness	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Rhinalgia	✓	✓	✓
SRO	Self-medication	✓	✓	✓

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