YSL-18903-43336

2 vaccinations 11 coded responses 18 check-ins 11 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 780 / TX
Registered: 2021-01-12

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

2021-01-05
Dose 1 — Moderna
2021-01-12
Registered in v-safe
2021-01-12
Survey response — day 7, dose 1
MedDRA: Erythema, Eye swelling, Feeling abnormal, Headache, Nausea, Ocular hyperaemia, Peripheral swelling, Rash, Self-medication, Swelling face — Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: 7th night body rash, Benedy solved, 10-11 left leg and face swelled, 12 on next day ok... since left eye and below Red and swollen, head ache 11 and today... do not feel good nauseates .... resting!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-12
Report sent to call center — day 7, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-19
Survey response — day 14, dose 1
MedDRA: Headache, Hypoacusis, Musculoskeletal stiffness — Feeling: Poor · Be unable to do your normal daily activities

Free text: Head ache, different... my neck is very stiff and my ears are??? Do not hear well on the left side. I have tested all day... it might be me!!! I actually had a dr. App. But cancelled, it was ortho... thank you

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Survey response — day 21, dose 1
MedDRA: Arthralgia, Back pain — Feeling: Fair

Free text: Just severe pain in my shoulders and back... but, honestly do not know if this is any connection with shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Dose 2 — Moderna
2021-02-09
Health check-in — day 0, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Pre-existing disease — Feeling: Good

Free text: Just same back pain that I had before shots!

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

Free text: I am always tired... not because of the shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-16
Health check-in — day 7, dose 2
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-02-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-02
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-11
Survey response — day 28, dose 2
MedDRA: Eye irritation, Fatigue, Myalgia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Muscle aches , burning eyes... just very tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Survey response — day 35, dose 2
MedDRA: Fatigue, Rash — Feeling: Fair · Be unable to do your normal daily activities

Free text: Feels like bladder infection, tired, rash and possibly small temp, resting and know what to do.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Survey response — day 42, dose 2
MedDRA: Abdominal pain, Back pain, Headache, Sensory disturbance, Tinnitus — Feeling: Fair · Be unable to do your normal daily activities

Free text: Pain in abdomen are and the Bach has hurt before, I have cracking ear and feel strange in head.. headache, just resting!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Survey response — 3 months, dose 2
MedDRA: Back pain, Burning sensation, Malaise, Mobility decreased, Muscular weakness, Pre-existing disease, Pruritus, Rash — Feeling: Poor · Be unable to do your normal daily activities

Free text: Body rash, I have to take a bath to try and relieve the burning itching. My back is very weak, hurts so, that its difficult to do anything. Swear a lot. Just feel very lousy...I have had health problems before this, so I do not know if I contribut

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-12
Survey response — 6 months, dose 2
MedDRA: Contusion, Fatigue, Ruptured cerebral aneurysm, Swelling — Feeling: Fair · Be unable to do your normal daily activities

Free text: Small blood vessels popping in brain., bruising, swelling... very tired!

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-02-09
Survey response — 12 months, dose 2
MedDRA: Balance disorder, Cystitis, Eye contusion, Kidney infection, Office visit — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Kidney, bladder infection falling , balance off and I had two black eyes · Healthcare visit (other): Two dr. App

MedDRA releases: 2024-11 · check-in free text available
2022-02-09
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-02-10
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-05	Moderna
2	2021-02-09	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-12	priority 2/3
2022-02-09	Successful 2022-02-10	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 1 — day 7, dose 1

2021-01-12

Systemic reaction (other): 7th night body rash, Benedy solved, 10-11 left leg and face swelled, 12 on next day ok... since left eye and below Red and swollen, head ache 11 and today... do not feel good nauseates .... resting!

Release 2 — day 14, dose 1

2021-01-19

Symptoms: Head ache, different... my neck is very stiff and my ears are??? Do not hear well on the left side. I have tested all day... it might be me!!! I actually had a dr. App. But cancelled, it was ortho... thank you

Release 2 — day 21, dose 1

2021-01-26

Symptoms: Just severe pain in my shoulders and back... but, honestly do not know if this is any connection with shot

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): Just same back pain that I had before shots!

2021-02-11

Systemic reaction (other): I am always tired... not because of the shot

Release 5 — day 28, dose 2

2021-03-11

Symptoms: Muscle aches , burning eyes... just very tired

Release 5 — day 35, dose 2

2021-03-16

Symptoms: Feels like bladder infection, tired, rash and possibly small temp, resting and know what to do.

Release 6 — day 42, dose 2

2021-03-23

Symptoms: Pain in abdomen are and the Bach has hurt before, I have cracking ear and feel strange in head.. headache, just resting!

Release 8 — 3 months, dose 2

2021-05-11

Symptoms: Body rash, I have to take a bath to try and relieve the burning itching. My back is very weak, hurts so, that its difficult to do anything. Swear a lot. Just feel very lousy...I have had health problems before this, so I do not know if I contribut

Release 9 — 6 months, dose 2

2021-08-12

Symptoms: Small blood vessels popping in brain., bruising, swelling... very tired!

Release 11 — 12 months, dose 2

2022-02-09

Symptoms: Kidney, bladder infection falling , balance off and I had two black eyes

Healthcare visit (other): Two dr. App

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	Abdominal pain	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Balance disorder	·	·	✓
SD	Burning sensation	✓	✓	✓
SD	Contusion	✓	·	✓
SD	Cystitis	·	·	✓
SD	Eye contusion	·	·	✓
SD	Eye irritation	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Haemorrhage intracranial	○	·	○
SD	Headache	✓	✓	✓
SD	Hypoacusis	✓	✓	✓
SD	Kidney infection	·	·	✓
SD	Malaise	✓	✓	✓
SD	Mobility decreased	✓	✓	✓
SD	Muscular weakness	✓	✓	✓
SD	Musculoskeletal stiffness	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Ruptured cerebral aneurysm	✓	·	✓
SD	Sensory disturbance	✓	✓	✓
SD	Swelling	✓	·	✓
SD	Tinnitus	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Eye swelling	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Ocular hyperaemia	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Swelling face	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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