2G8-18114-23417

3 vaccinations 9 coded responses 19 check-ins 9 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 776 / TX
Registered: 2021-01-13

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

2021-01-13
Registered in v-safe
2021-01-13
Dose 1 — Moderna
2021-01-22
Survey response — day 7, dose 1
MedDRA: No adverse event — Feeling: Poor · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-04-15
Survey response — 3 months, dose 1
MedDRA: Headache, Pain in extremity — Feeling: Poor · Be unable to do your normal daily activities

Free text: Headache. And pain in legs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-16
Dose 2 — Moderna
2021-07-16
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2021-07-16
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-07-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-07-20
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Joint pains, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Hospitalization

Free text: From my private insurance.

MedDRA releases: 2024-11 · check-in free text available
2021-07-20
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-07-22
Survey response — days 1–6 daily, dose 2
MedDRA: Systemic lupus erythematosus — Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lupus

MedDRA releases: 2024-11 · check-in free text available
2021-07-26
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-07-31
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-08-06
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-08-15
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-08-22
Survey response — day 35, dose 2
MedDRA: Pre-existing disease, SARS-CoV-2 test positive — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I tested positive for COVID. I am waiting for the doctor to call me because I have lupus and many more things that affects my immune system. · Healthcare visit (other): Took test and I am postive for COVID-19

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-22
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-24
Call 1 — Could Not Reach Participant
2021-08-25
Callback requested for
12:15PM ET
2021-08-25
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-15
Survey response — 3 months, dose 2
MedDRA: COVID-19, Office visit — Feeling: Fair · 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: Symptoms: Had COVID-19 · Healthcare visit (other): Doctors office

MedDRA releases: 2024-11 · check-in free text available
2021-10-15
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-19
Call 1 — Requested Callback
2021-10-20
Call 2 — Left Voicemail
2021-10-20
Callback requested for
02:00PM ET
2021-12-10
Dose 3 — Moderna
2022-01-16
Health check-in — day 35, dose 3
Feeling: Poor

Adult check-in
2022-01-23
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-03-12
Survey response — 3 months, dose 3
MedDRA: Blood test abnormal, Cardiac disorder, Hospitalisation — Feeling: Fair · Be unable to do your normal daily activities

Free text: Heart Problems and my blood count was 6.4.. I was in the hospital for a couple of weeks

MedDRA releases: 2024-11 · check-in free text available
2022-06-12
Survey response — 6 months, dose 3
MedDRA: Cardiac disorder, Full blood count decreased, Hospitalisation — Feeling: Fair · Be unable to do your normal daily activities

Free text: Low blood count, 6.5. There was something wrong with my heart. Spend 2 weeks in hospital.

MedDRA releases: 2024-11 · check-in free text available
2022-12-11
Survey response — 12 months, dose 3
MedDRA: Mobility decreased, Pre-existing disease, Systemic lupus erythematosus — Feeling: Fair · Be unable to do your normal daily activities

Free text: Lupus Flair and blood count under 10 , so I get Procrit shots about every 2 weeks. On top of that I have arthritis. Have a hard time getting around.

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-13	Moderna
2	2021-07-16	Moderna	No
3	2021-12-10	Moderna	No

Call center

3 call center cases

2 successful · 1 unsuccessful

See the call center timeline

Free text

Release 2 — day 7, dose 1

2021-01-22

Systemic reaction (other): No

Release 7 — 3 months, dose 1

2021-04-15

Symptoms: Headache. And pain in legs

Release 9 — days 1–6 daily, dose 2

2021-07-20

Healthcare visit (other): From my private insurance.

2021-07-22

Systemic reaction (other): Lupus

Release 9 — day 35, dose 2

2021-08-22

Symptoms: I tested positive for COVID. I am waiting for the doctor to call me because I have lupus and many more things that affects my immune system.

Healthcare visit (other): Took test and I am postive for COVID-19

Release 10 — 3 months, dose 2

2021-10-15

Symptoms: Had COVID-19

Healthcare visit (other): Doctors office

Release 11 — 3 months, dose 3

2022-03-12

Symptoms: Heart Problems and my blood count was 6.4.. I was in the hospital for a couple of weeks

Release 12 — 6 months, dose 3

2022-06-12

Symptoms: Low blood count, 6.5. There was something wrong with my heart. Spend 2 weeks in hospital.

Release 12 — 12 months, dose 3

2022-12-11

Symptoms: Lupus Flair and blood count under 10 , so I get Procrit shots about every 2 weeks. On top of that I have arthritis. Have a hard time getting around.

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	SARS-CoV-2 test positive	✓	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Blood test abnormal	·	·	✓
SD	Cardiac disorder	·	·	✓
SD	COVID-19	·	·	✓
SD	Full blood count decreased	·	·	✓
SD	Headache	✓	✓	✓
SD	Hospitalisation	·	·	✓
SD	Mobility decreased	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Pre-existing disease	✓	·	✓
SD	SARS-CoV-2 test positive	✓	·	✓
SD	Systemic lupus erythematosus	·	·	✓
SRO	No adverse event	✓	✓	✓
SRO	Systemic lupus erythematosus	·	·	✓

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