285-22154-77867

2 vaccinations 8 coded responses 19 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 781 / TX
Registered: 2021-03-05

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

2021-03-05
Registered in v-safe
2021-03-05
Dose 1 — Moderna
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-08
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good

Free text: I have had no side affects from the shot! (:

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good

Free text: I have had no side affects

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good

Free text: None

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

Adult check-in
2021-03-12
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-28
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-09
Dose 2 — Moderna
2021-04-09
Survey response — day 0, dose 2
MedDRA: Back pain, Pain — Feeling: Poor · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: I hurt all over my body, extreme lower back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: My dad,(b)(6) and mother, (b)(6)has this number for me to reply and dad (b)(6), has been really sick but has NOT received any notices. Please respond so I can report on them. This number was written down as their contact numbers.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Nausea — Feeling: Poor · Site: Pain · Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Back pain severe and nausea just started 3 pm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Office visit — Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, 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: Systemic reaction (other): Lower back pain- parents (b)(6) and (b)(6) never got notices from this same number to report symptoms. (b)(6) (b)(6) has been very ill! Fever, chills, nausea, vomiting. · Healthcare visit (other): Doctors appt

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Report sent to call center — days 1–6 daily, 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)
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Adult check-in
2021-04-14
Report sent to call center — days 1–6 daily, 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)
2021-04-15
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Feeling better. Less back pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-01
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2022-03-28
Call 1 — Left Voicemail
2022-03-31
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-05	Moderna
2	2021-04-09	Moderna

Call center

2 call center cases

2 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-08

Systemic reaction (other): I have had no side affects from the shot! (:

2021-03-09

Systemic reaction (other): I have had no side affects

2021-03-10

Systemic reaction (other): None

Release 7 — day 0, dose 2

2021-04-09

Systemic reaction (other): I hurt all over my body, extreme lower back pain

Release 7 — days 1–6 daily, dose 2

2021-04-11

Systemic reaction (other): My dad,(b)(6) and mother, (b)(6)has this number for me to reply and dad (b)(6), has been really sick but has NOT received any notices. Please respond so I can report on them. This number was written down as their contact numbers.

redacted (b)(6)

2021-04-12

Systemic reaction (other): Back pain severe and nausea just started 3 pm

2021-04-13

Systemic reaction (other): Lower back pain- parents (b)(6) and (b)(6) never got notices from this same number to report symptoms. (b)(6) (b)(6) has been very ill! Fever, chills, nausea, vomiting.

Healthcare visit (other): Doctors appt

redacted (b)(6)

2021-04-15

Systemic reaction (other): Feeling better. Less back pain.

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	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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