35A-16604-26141

5 vaccinations 11 coded responses 38 check-ins 11 free-text entries 3 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 009 / PR
Registered: 2021-04-08

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Timeline

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

2021-03-22
Dose 1 — Moderna
2021-04-08
Registered in v-safe
2021-04-08
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-12
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-19
Dose 2 — Moderna
2021-04-19
Survey response — day 0, dose 2
MedDRA: Pyrexia — Feeling: Fair · Fever · Headache, Nausea

Free text: A little fever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · Headache

Adult check-in
2021-04-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · Headache, Nausea

Adult check-in
2021-04-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · Fatigue or tiredness

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-26
Health check-in — day 7, dose 2
Feeling: Fair · Fever · Headache · Be unable to do your normal daily activities

Adult check-in
2021-05-03
Survey response — day 14, dose 2
MedDRA: Fatigue, Headache, Office visit, Pyrexia — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Symptoms: Headaches, fever, fatigue · Healthcare visit (other): Neurologists appoint on person

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-17
Survey response — day 28, dose 2
MedDRA: Fatigue, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fever, fatigue, tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-24
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-31
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-21
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-19
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-23
Dose 3 — Moderna
Co-administered: Shingles
2021-10-30
Survey response — day 7, dose 3
MedDRA: Pre-existing disease — Feeling: Fair

Free text: Nose allergy

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Survey response — day 14, dose 3
MedDRA: Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Mitochondrial enzymatic disorder. Not related because since 2016 had have sintoms but not until recently i had a gene test and a pathalogical gene of it.

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Report sent to call center — day 14, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-09
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-17
Survey response — day 21, dose 3
MedDRA: Fall, Mitochondrial enzyme deficiency — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Hospitalization

Free text: Symptoms: Falls due to mitocondrial enzymatic symdrome · Healthcare visit (other): Due to the falls

MedDRA releases: 2024-11 · check-in free text available
2021-11-17
Report sent to call center — day 21, 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

Telehealth, virtual health, or email health consultation · Hospitalization · 1 call case(s)
2021-11-18
Call 1 — Left Voicemail
2021-11-18
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-20
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-11-27
Survey response — day 35, dose 3
MedDRA: Asthenia, Dyspnoea, Emergency care, Fall, Hypersomnia, Poisoning — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Got intoxicaded with a mild deterger and I unable to breath. Had to go to a hospital in an ambualance. I also falled today. And sleped most of the day the 25, 26. Very weak a cople of days includin today.

MedDRA releases: 2024-11 · check-in free text available
2021-12-04
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-22
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-04-08
Dose 4 — Moderna
2022-04-23
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-05-22
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-10
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-04
Dose 5 — Moderna
Co-administered: Flu:Tetanus
2022-10-07
Survey response — 6 months, dose 4
MedDRA: Osteoporosis, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Osteosporosisn, genetic mitochondrial disorder

MedDRA releases: 2024-11 · check-in free text available
2022-10-07
Survey response — days 1–6 daily, dose 5
MedDRA: Injection site pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: The next day of the booster i had pain in the muscle where they put the booster

MedDRA releases: 2024-11 · check-in free text available
2022-10-09
Survey response — days 1–6 daily, dose 5
MedDRA: Fall, Gait disturbance, Muscular weakness — Feeling: Good · Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Muscle weaknes. Easily falling and walking weird

MedDRA releases: 2024-11 · check-in free text available
2022-10-10
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-13
Survey response — day 7, dose 5
MedDRA: Depressed mood — Feeling: Fair

Free text: Felt down yesterday

MedDRA releases: 2024-11 · check-in free text available
2022-10-18
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-25
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-01
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-08
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-15
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-03
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-04-04
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-22	Moderna
2	2021-04-19	Moderna
3	2021-10-23	Moderna	Shingles
4	2022-04-08	Moderna	No
5	2022-10-04	Moderna	Flu:Tetanus

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 7 — day 0, dose 2

2021-04-19

Systemic reaction (other): A little fever

Release 8 — day 14, dose 2

2021-05-03

Symptoms: Headaches, fever, fatigue

Healthcare visit (other): Neurologists appoint on person

Release 8 — day 28, dose 2

2021-05-17

Symptoms: Fever, fatigue, tired

Release 10 — day 7, dose 3

2021-10-30

Systemic reaction (other): Nose allergy

Release 10 — day 14, dose 3

2021-11-06

Symptoms: Mitochondrial enzymatic disorder. Not related because since 2016 had have sintoms but not until recently i had a gene test and a pathalogical gene of it.

Release 10 — day 21, dose 3

2021-11-17

Symptoms: Falls due to mitocondrial enzymatic symdrome

Healthcare visit (other): Due to the falls

Release 10 — day 35, dose 3

2021-11-27

Symptoms: Got intoxicaded with a mild deterger and I unable to breath. Had to go to a hospital in an ambualance. I also falled today. And sleped most of the day the 25, 26. Very weak a cople of days includin today.

Release 12 — 6 months, dose 4

2022-10-07

Symptoms: Osteosporosisn, genetic mitochondrial disorder

Release 12 — days 1–6 daily, dose 5

2022-10-07

Systemic reaction (other): The next day of the booster i had pain in the muscle where they put the booster

2022-10-09

Systemic reaction (other): Muscle weaknes. Easily falling and walking weird

Release 12 — day 7, dose 5

2022-10-13

Systemic reaction (other): Felt down yesterday

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	Fall	·	·	✓
HCVO	Office visit	✓	✓	✓
SD	Asthenia	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Emergency care	·	·	✓
SD	Fall	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypersomnia	·	·	✓
SD	Mitochondrial enzyme deficiency	·	·	✓
SD	Osteoporosis	·	·	✓
SD	Poisoning	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	✓	✓	✓
SRO	Depressed mood	·	·	✓
SRO	Fall	·	·	✓
SRO	Gait disturbance	·	·	✓
SRO	Injection site pain	·	·	✓
SRO	Muscular weakness	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Pyrexia	✓	✓	✓

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