34W-13211-25435
3 vaccinations
4 coded responses
23 check-ins
4 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 921 / CA
- Registered
- 2021-02-06
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-05
Dose 1 — Moderna
-
2021-02-06
Registered in v-safe
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-11
-
2021-02-12
Survey response — day 7, dose 1MedDRA: Headache, Sensitivity to weather change — Feeling: Good · HeadacheFree text: I believe headache unrelated to Covid shot. Weather/pressure change probably cause.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-19
- 2021-02-26
- 2021-03-05
-
2021-03-13
Survey response — day 35, dose 1MedDRA: Computerised tomogram, Emergency care, Presyncope, Syncope — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Yesterday I fainted and fell hitting my head. I ended up in the emergency room for 4 hours. After a CT scan & blood tests I was diagnosed with a vasovagal syncope. Per doctors nothing related to Covid. I was released to go home last night.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-13
Report sent to call center — day 35, dose 1Get care from a doctor or other healthcare professional1 call case(s)
-
2021-03-15
Dose 2 — Moderna
- 2021-03-19
- 2021-03-20
- 2021-03-21
-
2021-03-22
Survey response — day 7, dose 2MedDRA: Fatigue — Feeling: Fair · Fatigue or tirednessFree text: Fatigue may not be related to Covid shot. Was on new Blood Pressure med which may be cause. Dr. has taken me off that med.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-29
- 2021-04-05
- 2021-04-12
- 2021-04-19
- 2021-04-26
- 2021-06-14
- 2021-09-13
- 2021-10-13
-
2021-10-18
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-11-08
Dose 3 — Moderna
-
2022-03-15
Survey response — 12 months, dose 2MedDRA: Craniofacial fracture, Fall, Incorrect dose administered, Office visit, Syncope — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Symptoms: Nov'21 had syncope episode the day after 3rd Covid shot (full dose rather than booster). Fell & fractured left cheekbone in 4 places. Still undergoing tests to determine if any other underlying condition that may have caused syncope. · Healthcare visit (other): Multiple in-office visits with Primary care and specialists for various testsMedDRA releases: 2024-11 · check-in free text available
-
2022-03-15
Report sent to call center — 12 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
-
2022-03-16
Call successfulParticipant prefers to complete VAERS report online
- 2022-05-09
- 2022-11-09
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-05 | Moderna | |
| 2 | 2021-03-15 | Moderna | |
| 3 | 2021-11-08 | Moderna | No |
Call center
2 call center cases
2 successful
1 wait over 3 months for a first call
Free text
Release 4 — day 7, dose 1
Systemic reaction (other): I believe headache unrelated to Covid shot. Weather/pressure change probably cause.
Release 5 — day 35, dose 1
Symptoms: Yesterday I fainted and fell hitting my head. I ended up in the emergency room for 4 hours. After a CT scan & blood tests I was diagnosed with a vasovagal syncope. Per doctors nothing related to Covid. I was released to go home last night.
Release 6 — day 7, dose 2
Systemic reaction (other): Fatigue may not be related to Covid shot. Was on new Blood Pressure med which may be cause. Dr. has taken me off that med.
Release 11 — 12 months, dose 2
Symptoms: Nov'21 had syncope episode the day after 3rd Covid shot (full dose rather than booster). Fell & fractured left cheekbone in 4 places. Still undergoing tests to determine if any other underlying condition that may have caused syncope.
Healthcare visit (other): Multiple in-office visits with Primary care and specialists for various tests
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 | · | · | ✓ |
| SD | Computerised tomogram | ✓ | ✓ | ✓ |
| SD | Craniofacial fracture | · | · | ✓ |
| SD | Emergency care | ✓ | ✓ | ✓ |
| SD | Fall | · | · | ✓ |
| SD | Incorrect dose administered | · | · | ✓ |
| SD | Presyncope | ✓ | ✓ | ✓ |
| SD | Syncope | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Sensitivity to weather change | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release