2L8-28733-37969

3 vaccinations 7 coded responses 31 check-ins 6 free-text entries 1 call case

Sex: Female
Age at first dose: 36-40
ZIP prefix: 774 / TX
Registered: 2021-03-04

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Registered dependents

NCM-32257-84103 Child or adolescent in my care · Female · 2021-11-12

XVS-25726-80211 Child or adolescent in my care · Male · 2021-11-12

4BD-26082-85268 Child or adolescent in my care · Male · 2021-11-12

Timeline

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

2021-03-04
Registered in v-safe
2021-03-04
Dose 1 — Janssen/Johnson & Johnson
2021-03-04
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache

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

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-18
Survey response — day 14, dose 1
MedDRA: Chest pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Random stabbing pain in my chest.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Health check-in — day 21, single dose
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 28, single dose
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 35, single dose
Feeling: Good

Adult check-in
2021-04-17
Survey response — day 42, single dose
MedDRA: Chest pain, Pain in extremity — Feeling: Fair

Free text: Pain in arm where I got the vaccine. Hurting legs and random chest pains. Symptoms are not constant they come and go.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-02
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2021-11-12
Dose 2 — Moderna
2021-11-12
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-14
Survey response — days 1–6 daily, dose 2
MedDRA: Axillary pain, Hypoaesthesia — Feeling: Good · Site: Pain

Free text: Sometimes my arm fells numb like you body feels when a body part is tired or what people say as falling to sleep. My underarm hurts on the arm where I a got my vaccination.

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-11-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-11-20
Health check-in — day 7, dose 2
Feeling: Fair · Muscle or body aches

Adult check-in
2021-11-27
Survey response — day 14, dose 2
MedDRA: Cough — Feeling: Good

Free text: Slight cough

MedDRA releases: 2024-11 · check-in free text available
2021-12-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-12-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-12-20
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-12-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2022-02-11
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-05-13
Survey response — 6 months, dose 2
MedDRA: Chest pain, Hypoaesthesia, Painful respiration — Feeling: Fair · Be unable to do your normal daily activities

Free text: Random chest pains, random pain in my lungs when breathing, feeling like my arms, legs, and or finger are numb.

MedDRA releases: 2024-11 · check-in free text available
2022-11-16
Dose 3 — Moderna
Co-administered: Flu
2022-11-17
Survey response — 12 months, dose 2
MedDRA: Brain fog, COVID-19, Chest pain, Headache, Hypoaesthesia, Pain, Paraesthesia — Feeling: Good

Free text: I have been experiencing brain fog and also vibration in my foot. I also feel like limbs feel numb sometimes. I have also been experiencing slight headaches and chest pains recently. It kinda reminds me of the pains I experienced during Covid.

MedDRA releases: 2024-11 · check-in free text available
2022-12-06
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2023-05-17
Survey response — 6 months, dose 3
MedDRA: Chest pain, Dyspnoea, Emergency care, Heart rate increased, Office visit — 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 · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11
2023-05-17
Report sent to call center — 6 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2023-05-18
Call 1 — Could Not Reach Participant
2023-05-23
Call 2 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-04	Janssen/Johnson & Johnson
2	2021-11-12	Moderna	No
3	2022-11-16	Moderna	Flu

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 5 — day 14, dose 1

2021-03-18

Symptoms: Random stabbing pain in my chest.

Release 7 — day 42, single dose

2021-04-17

Symptoms: Pain in arm where I got the vaccine. Hurting legs and random chest pains. Symptoms are not constant they come and go.

Release 10 — days 1–6 daily, dose 2

2021-11-14

Systemic reaction (other): Sometimes my arm fells numb like you body feels when a body part is tired or what people say as falling to sleep. My underarm hurts on the arm where I a got my vaccination.

Release 10 — day 14, dose 2

2021-11-27

Symptoms: Slight cough

Release 11 — 6 months, dose 2

2022-05-13

Symptoms: Random chest pains, random pain in my lungs when breathing, feeling like my arms, legs, and or finger are numb.

Release 12 — 12 months, dose 2

2022-11-17

Symptoms: I have been experiencing brain fog and also vibration in my foot. I also feel like limbs feel numb sometimes. I have also been experiencing slight headaches and chest pains recently. It kinda reminds me of the pains I experienced during Covid.

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	Brain fog	·	·	✓
SD	Chest pain	✓	✓	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Emergency care	·	·	✓
SD	Headache	·	·	✓
SD	Heart rate increased	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Office visit	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Painful respiration	·	·	✓
SD	Paraesthesia	·	·	✓
SRO	Axillary pain	·	·	✓
SRO	Hypoaesthesia	·	·	✓

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