YV9-19188-61823

2 vaccinations 7 coded responses 26 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 973 / OR
Registered: 2021-04-06

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-04-06
Registered in v-safe
2021-04-06
Dose 1 — Moderna
2021-04-06
Survey response — day 0, dose 1
MedDRA: Headache — Feeling: Fair · Site: Pain · Headache

Free text: Headache is a solid moderate,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 1
MedDRA: Blood glucose decreased — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Low Blood sugar this morning and this afternoon. May not be related to getting shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-04-13
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain

Adult check-in
2021-04-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-04
Dose 2 — Moderna
2021-05-04
Health check-in — day 0, dose 2
Feeling: Good · Headache

Adult check-in
2021-05-05
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · 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
2021-05-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains

Adult check-in
2021-05-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-11
Health check-in — day 7, dose 2
Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-09
Survey response — day 35, dose 2
MedDRA: Hospitalisation, Peripheral arterial occlusive disease, Procedure aborted, Unevaluable event — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: R leg Arterial damage. Surgery was scheduled, camera used to find blockage. Surgery aborted, rescheduled for another hospital per surgeon. · Healthcare visit (other): Short stay

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-09
Report sent to call center — day 35, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-15
Survey response — day 42, dose 2
MedDRA: Abdominal discomfort, Bowel movement irregularity, Diarrhoea, Headache — Feeling: Fair

Free text: Upset stomach, irregula/ loose bowel movents. Headache, all around puny

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-03
Survey response — 3 months, dose 2
MedDRA: Surgery, Transplant — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: Had to have a vein transplant · Healthcare visit (other): Surgery

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-03
Report sent to call center — 3 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-08-12
Call 1 — Left Voicemail
2021-11-02
Survey response — 6 months, dose 2
MedDRA: Thrombectomy, Thrombosis — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I had a blood clot in my leg that was removed sat oct 30tg

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
Survey response — 12 months, dose 2
MedDRA: Adverse reaction, Cellulitis, Feeling hot, Medical counselling, Nasopharyngitis, Rash, Tremor — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Cellulitus in left arm. Arm was hot, rash, i had shakes, cold. Received 10x4 per day antibiotics · Healthcare visit (other): Spoke to nurse over phone, reoccuring symptoms. Antibiotics keep me out of hospital

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2022-05-05
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-06	Moderna
2	2021-05-04	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-06-09	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-08-03	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-04	Successful 2022-05-05	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 7 — day 0, dose 1

2021-04-06

Systemic reaction (other): Headache is a solid moderate,

Release 7 — days 1–6 daily, dose 1

2021-04-07

Systemic reaction (other): Low Blood sugar this morning and this afternoon. May not be related to getting shot.

Release 9 — day 35, dose 2

2021-06-09

Symptoms: R leg Arterial damage. Surgery was scheduled, camera used to find blockage. Surgery aborted, rescheduled for another hospital per surgeon.

Healthcare visit (other): Short stay

Release 9 — day 42, dose 2

2021-06-15

Symptoms: Upset stomach, irregula/ loose bowel movents. Headache, all around puny

Release 9 — 3 months, dose 2

2021-08-03

Symptoms: Had to have a vein transplant

Healthcare visit (other): Surgery

Release 10 — 6 months, dose 2

2021-11-02

Symptoms: I had a blood clot in my leg that was removed sat oct 30tg

Release 11 — 12 months, dose 2

2022-05-04

Symptoms: Cellulitus in left arm. Arm was hot, rash, i had shakes, cold. Received 10x4 per day antibiotics

Healthcare visit (other): Spoke to nurse over phone, reoccuring symptoms. Antibiotics keep me out of hospital

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	Adverse reaction	·	·	✓
HCVO	Medical counselling	·	·	✓
HCVO	Surgery	✓	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Abdominal discomfort	✓	✓	✓
SD	Bowel movement irregularity	✓	✓	✓
SD	Cellulitis	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Feeling hot	·	·	✓
SD	Headache	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Peripheral arterial occlusive disease	✓	✓	✓
SD	Procedure aborted	✓	✓	✓
SD	Rash	·	·	✓
SD	Thrombectomy	·	·	✓
SD	Thrombosis	·	·	✓
SD	Transplant	✓	·	✓
SD	Tremor	·	·	✓
SRO	Blood glucose decreased	✓	✓	✓
SRO	Headache	✓	✓	✓

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