2YE-27961-25044

3 vaccinations 8 coded responses 30 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 794 / TX
Registered: 2021-01-26

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

URE-46867-52144 Child or adolescent in my care · Male · 2021-11-12

LFW-19384-60084 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

2020-12-31
Dose 1 — Moderna
2021-01-26
Registered in v-safe
2021-01-26
Dose 2 — Moderna
2021-01-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-26
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fever · Headache

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-02-02
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-09
Survey response — day 42, dose 2
MedDRA: Bundle branch block left, Electrocardiogram, Electrocardiogram abnormal — Feeling: Good · Be unable to work, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: EKG LBBB, unexplained cause. Angiogram negative for blockage.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Report sent to call center — day 42, dose 2
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-27
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-27
Survey response — 6 months, dose 2
MedDRA: Myocardial bridging, Nasal necrosis, Palpitations — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Myocardial bridging, chest palpitations, necrosis on septum found via cath.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-27
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-03
Call 1 — Left Voicemail
2021-11-10
Dose 3 — Pfizer-BioNTech
2021-11-11
Survey response — days 1–6 daily, dose 3
MedDRA: Dyspnoea — Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness, Diarrhea

Free text: Shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Survey response — days 1–6 daily, dose 3
MedDRA: Dyspnoea — Feeling: Good · Site: Pain

Free text: Shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-14
Survey response — days 1–6 daily, dose 3
MedDRA: Myocarditis, Vaccine positive rechallenge — Feeling: Fair

Free text: Myocarditis, same as it was with my second dose 9 months ago. It has gone away completely 7 months ago. No incidents, now, 4 days after my booster, it's back.

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Survey response — days 1–6 daily, dose 3
MedDRA: Chest pain, Myocarditis — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Chest pain, myocarditis

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Survey response — days 1–6 daily, dose 3
MedDRA: Chest pain, Lymphadenopathy, Myocarditis — Feeling: Fair

Free text: Large swollen (side of an almond) collar bone lymph node on vaccine side. Minor chest pain myocarditis requiring nitro

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-26
Survey response — day 14, dose 3
MedDRA: Angina pectoris, Myocarditis — Feeling: Fair

Free text: Same problem with random angina. Haven't narrowed a reason. It went away for over 8 months, then returned days after my booster. Have to take nitro to make it stop. Diagnosed with myocarditis after the last shot (second dose).

MedDRA releases: 2024-11 · check-in free text available
2021-12-01
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-22
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-05-11
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-12
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-31	Moderna
2	2021-01-26	Moderna
3	2021-11-10	Pfizer-BioNTech	No

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 5 — day 42, dose 2

2021-03-09

Symptoms: EKG LBBB, unexplained cause. Angiogram negative for blockage.

Release 9 — 6 months, dose 2

2021-07-27

Symptoms: Myocardial bridging, chest palpitations, necrosis on septum found via cath.

Release 10 — days 1–6 daily, dose 3

2021-11-11

Systemic reaction (other): Shortness of breath

2021-11-12

Systemic reaction (other): Shortness of breath

2021-11-14

Systemic reaction (other): Myocarditis, same as it was with my second dose 9 months ago. It has gone away completely 7 months ago. No incidents, now, 4 days after my booster, it's back.

2021-11-15

Systemic reaction (other): Chest pain, myocarditis

2021-11-16

Systemic reaction (other): Large swollen (side of an almond) collar bone lymph node on vaccine side. Minor chest pain myocarditis requiring nitro

Release 10 — day 14, dose 3

2021-11-26

Symptoms: Same problem with random angina. Haven't narrowed a reason. It went away for over 8 months, then returned days after my booster. Have to take nitro to make it stop. Diagnosed with myocarditis after the last shot (second dose).

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	Angina pectoris	·	·	✓
SD	Bundle branch block left	✓	✓	✓
SD	Electrocardiogram	○	✓	○
SD	Electrocardiogram abnormal	✓	·	✓
SD	Myocardial bridging	✓	·	✓
SD	Myocarditis	·	·	✓
SD	Nasal necrosis	✓	·	✓
SD	Palpitations	✓	·	✓
SRO	Chest pain	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Myocarditis	·	·	✓
SRO	Vaccine positive rechallenge	·	·	✓

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