ZSK-26071-85741

2 vaccinations 10 coded responses 21 check-ins 10 free-text entries 2 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 142 / NY
Registered: 2021-04-02

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

2021-04-02
Registered in v-safe
2021-04-02
Dose 1 — Moderna
2021-04-02
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-04-03
Survey response — days 1–6 daily, dose 1
MedDRA: Eye pain — Feeling: Fair · Site: Pain · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Pain behind my left eye

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Survey response — days 1–6 daily, dose 1
MedDRA: Eye pain — Feeling: Poor · Site: Pain, Itching · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Eye pain behind left eye

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Chills

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-07
Survey response — days 1–6 daily, dose 1
MedDRA: Eye pain, Photophobia — Feeling: Poor · Chills, Headache, Joint pains, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Eye pain coming back left eye behind my eye & sensitivity to light

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Survey response — days 1–6 daily, dose 1
MedDRA: Angle closure glaucoma, Eye pain, Pre-existing disease — Feeling: Fair · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Still having eye pain, left eye I do have closed angle glaucoma in that eye had it for three years now

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-09
Health check-in — day 7, dose 1
Feeling: Good · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-04-16
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-23
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-30
Dose 2 — Moderna
2021-05-01
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: No appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Eye pain, Glaucoma, Pre-existing disease — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: No appetite; pain in left eye where I have closed angle glaucoma

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Survey response — days 1–6 daily, dose 2
MedDRA: Angle closure glaucoma, Eye pain — Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Vomiting · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Eye pain in my left eye that has closed angle glaucoma

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains · Be unable to do your normal daily activities

Adult check-in
2021-05-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-07
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-14
Survey response — day 14, dose 2
MedDRA: Blood glucose increased, Diabetes mellitus, Oedema peripheral, Pre-existing disease, Weight increased — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Swollen armpits and sudden weight gain; by blood sugars have gone up enough to make me have to go back on insulin ( I had been off both long acting &!/ short acting for a year ) now I cant keep my fast under 140 no matter what!!!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-21
Survey response — day 21, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Extreme fatigue

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

Adult check-in
2021-06-04
Survey response — day 35, dose 2
MedDRA: Blood glucose abnormal, Fatigue — Feeling: Poor · Be unable to do your normal daily activities

Free text: Extreme fatigue keeps coming & going & my glucose levels are NOT back to pre Moderna levels

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-11
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2022-04-01
Call 1 — Could Not Reach Participant
2022-04-06
Call 2 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-02	Moderna
2	2021-04-30	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-04-08	Unsuccessful
2021-05-14	Unsuccessful

Free text

Release 6 — days 1–6 daily, dose 1

2021-04-03

Systemic reaction (other): Pain behind my left eye

2021-04-04

Systemic reaction (other): Eye pain behind left eye

Release 7 — days 1–6 daily, dose 1

2021-04-07

Systemic reaction (other): Eye pain coming back left eye behind my eye & sensitivity to light

2021-04-08

Systemic reaction (other): Still having eye pain, left eye I do have closed angle glaucoma in that eye had it for three years now

Release 8 — days 1–6 daily, dose 2

2021-05-01

Systemic reaction (other): No appetite

2021-05-02

Systemic reaction (other): No appetite; pain in left eye where I have closed angle glaucoma

2021-05-04

Systemic reaction (other): Eye pain in my left eye that has closed angle glaucoma

Release 8 — day 14, dose 2

2021-05-14

Symptoms: Swollen armpits and sudden weight gain; by blood sugars have gone up enough to make me have to go back on insulin ( I had been off both long acting &!/ short acting for a year ) now I cant keep my fast under 140 no matter what!!!

Release 8 — day 21, dose 2

2021-05-21

Symptoms: Extreme fatigue

Release 8 — day 35, dose 2

2021-06-04

Symptoms: Extreme fatigue keeps coming & going & my glucose levels are NOT back to pre Moderna levels

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
SD	Blood glucose abnormal	✓	✓	✓
SD	Blood glucose increased	✓	✓	✓
SD	Diabetes mellitus	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Oedema peripheral	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Weight increased	✓	✓	✓
SRO	Angle closure glaucoma	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Eye pain	✓	✓	✓
SRO	Glaucoma	○	✓	○
SRO	Photophobia	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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