ZAP-13177-49615

2 vaccinations 6 coded responses 12 check-ins 6 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 427 / KY
Registered: 2021-02-17

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

2021-02-03
Dose 1 — Moderna
2021-02-17
Registered in v-safe
2021-02-17
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-26
Survey response — day 21, dose 1
MedDRA: Office visit, Pain in extremity — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Leg pain · Healthcare visit (other): Family Doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-03
Survey response — day 28, dose 1
MedDRA: Deep vein thrombosis, Office visit, Pulmonary embolism — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I have a DVT in my right leg. Also a PE in my lungs. I get my second Moderna Vaccination tomorrow morning. · Healthcare visit (other): Doctor appointment. He ordered Ultrasound of leg and chest CAT Scan.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Report sent to call center — day 28, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-04
Dose 2 — Moderna
2021-03-10
Survey response — days 1–6 daily, dose 2
MedDRA: Office visit, Pulmonary embolism, Thrombosis — Feeling: Good · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): 2 weeks after first vaccine I developed a blood clot in my right leg. Also a PE in my lung. · Healthcare visit (other): Family Doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-11
Survey response — day 7, dose 2
MedDRA: Deep vein thrombosis, Office visit, Pulmonary embolism — Feeling: Good · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): After first Vaccination I developed a DVT and PE two weeks after. · Healthcare visit (other): Family Doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Report sent to call center — day 7, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-18
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-25
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-01
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-08
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-17
Survey response — day 42, dose 2
MedDRA: Office visit, Pulmonary embolism — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Blood clot in my leg and PE in lung (that happened 2 weeks after first Vaccination) keeps me from doing any outdoor activities. · Healthcare visit (other): Family Doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-03
Survey response — 3 months, dose 2
MedDRA: Deep vein thrombosis, Dyspnoea, Office visit, Pulmonary embolism — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Not sure if Pulmonary embolism is still in lung. Also I continue to be short of breath. Blood clots in right leg are better. · Healthcare visit (other): Family doctor was able to get me in pretty soon.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-03
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-17
Call successful
Participant prefers to complete VAERS report online
2021-09-02
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-03	Moderna
2	2021-03-04	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-02-26	Successful	Participant prefers to complete VAERS report online
2021-03-03	Successful	Participant prefers to complete VAERS report online
2021-03-10	Successful	Participant prefers to complete VAERS report online
2021-03-11	Successful	Participant prefers to complete VAERS report online
2021-04-17	Successful	Participant prefers to complete VAERS report online
2021-06-03	Successful 2021-06-17	Participant prefers to complete VAERS report online

Free text

Release 4 — day 21, dose 1

2021-02-26

Symptoms: Leg pain

Healthcare visit (other): Family Doctor

Release 5 — day 28, dose 1

2021-03-03

Symptoms: I have a DVT in my right leg. Also a PE in my lungs. I get my second Moderna Vaccination tomorrow morning.

Healthcare visit (other): Doctor appointment. He ordered Ultrasound of leg and chest CAT Scan.

Release 5 — days 1–6 daily, dose 2

2021-03-10

Systemic reaction (other): 2 weeks after first vaccine I developed a blood clot in my right leg. Also a PE in my lung.

Healthcare visit (other): Family Doctor

Release 5 — day 7, dose 2

2021-03-11

Systemic reaction (other): After first Vaccination I developed a DVT and PE two weeks after.

Healthcare visit (other): Family Doctor

Release 7 — day 42, dose 2

2021-04-17

Symptoms: Blood clot in my leg and PE in lung (that happened 2 weeks after first Vaccination) keeps me from doing any outdoor activities.

Healthcare visit (other): Family Doctor

Release 8 — 3 months, dose 2

2021-06-03

Symptoms: Not sure if Pulmonary embolism is still in lung. Also I continue to be short of breath. Blood clots in right leg are better.

Healthcare visit (other): Family doctor was able to get me in pretty soon.

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	Deep vein thrombosis	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pulmonary embolism	✓	✓	✓
SRO	Deep vein thrombosis	✓	✓	✓
SRO	Pulmonary embolism	✓	✓	✓
SRO	Thrombosis	✓	✓	✓

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