YU4-17951-84962

2 vaccinations 11 coded responses 25 check-ins 11 free-text entries 2 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 973 / OR
Registered: 2021-03-25

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

2021-03-25
Registered in v-safe
2021-03-25
Dose 1 — Moderna
2021-03-26
Survey response — days 1–6 daily, dose 1
MedDRA: Herpes simplex, Pre-existing disease — Feeling: Good · Site: Pain

Free text: Herpes outbreak

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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
Survey response — day 7, dose 1
MedDRA: Dizziness — Feeling: Good

Free text: Dizzy when I woke up in the morning

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-15
Survey response — day 21, dose 1
MedDRA: Lip swelling, Specialist consultation — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: My lips puffed up for several days starting 4/16/21. · Healthcare visit (other): Visit with primary care physician

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-22
Dose 2 — Moderna
2021-04-22
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-24
Survey response — days 1–6 daily, dose 2
MedDRA: Herpes virus infection — Feeling: Good · Site: Pain · Headache

Free text: Herpes outbreak

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Survey response — days 1–6 daily, dose 2
MedDRA: Angioedema, Vaccine positive rechallenge — Feeling: Good · Site: Pain

Free text: Angiodema on my lips. Also happened 3 weeks after my first shot. Could be an increased sensitivity to tomatoes.

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: Angioedema — Feeling: Good

Free text: Angiodema on my lips

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Survey response — days 1–6 daily, dose 2
MedDRA: Ophthalmic migraine — Feeling: Good

Free text: Ocular migraine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Survey response — days 1–6 daily, dose 2
MedDRA: Angioedema — Feeling: Good

Free text: Angiodema (lips)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Survey response — day 7, dose 2
MedDRA: Angioedema — Feeling: Good

Free text: Angiodema still

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-13
Survey response — day 21, dose 2
MedDRA: Chapped lips, Dizziness, Food allergy, Lip swelling — Feeling: Good

Free text: Occasional light headed feelings; continued allergic reaction to tomatoes (lips swell and serious chapping)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-27
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-03
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-22
Survey response — 6 months, dose 2
MedDRA: Neuropathy peripheral, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Peripheral neuropathy (feet) · Healthcare visit (other): Annual check up with my NP

MedDRA releases: 2024-11 · check-in free text available
2021-10-22
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-25
Call 1 — Left Voicemail
2022-04-22
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-25	Moderna
2	2021-04-22	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-04-15	Unsuccessful
2021-10-22	Unsuccessful

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-26

Systemic reaction (other): Herpes outbreak

Release 6 — day 7, dose 1

2021-04-01

Systemic reaction (other): Dizzy when I woke up in the morning

Release 7 — day 21, dose 1

2021-04-15

Symptoms: My lips puffed up for several days starting 4/16/21.

Healthcare visit (other): Visit with primary care physician

Release 7 — days 1–6 daily, dose 2

2021-04-24

Systemic reaction (other): Herpes outbreak

2021-04-25

Systemic reaction (other): Angiodema on my lips. Also happened 3 weeks after my first shot. Could be an increased sensitivity to tomatoes.

Release 8 — days 1–6 daily, dose 2

2021-04-26

Systemic reaction (other): Angiodema on my lips

2021-04-27

Systemic reaction (other): Ocular migraine

2021-04-28

Systemic reaction (other): Angiodema (lips)

Release 8 — day 7, dose 2

2021-04-29

Systemic reaction (other): Angiodema still

Release 8 — day 21, dose 2

2021-05-13

Symptoms: Occasional light headed feelings; continued allergic reaction to tomatoes (lips swell and serious chapping)

Release 10 — 6 months, dose 2

2021-10-22

Symptoms: Peripheral neuropathy (feet)

Healthcare visit (other): Annual check up with my NP

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	·	·	✓
HCVO	Specialist consultation	✓	✓	✓
SD	Chapped lips	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Food allergy	✓	✓	✓
SD	Lip swelling	✓	✓	✓
SD	Neuropathy peripheral	·	·	✓
SRO	Angioedema	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Herpes simplex	✓	✓	✓
SRO	Herpes virus infection	✓	✓	✓
SRO	Ophthalmic migraine	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Vaccine positive rechallenge	✓	✓	✓

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