3JR-28866-27001
4 vaccinations
7 coded responses
47 check-ins
7 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 785 / TX
- Registered
- 2021-02-11
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-11
Registered in v-safe
-
2021-02-11
Dose 1 — Moderna
- 2021-02-11
-
2021-02-12
Health check-in — days 1–6 daily, dose 1Feeling: Poor · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
-
2021-02-13
Survey response — days 1–6 daily, dose 1MedDRA: Feeling abnormal — Feeling: Fair · Chills, Muscle or body aches · Be unable to do your normal daily activitiesFree text: Brain FogMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-14
- 2021-02-15
- 2021-02-16
- 2021-02-18
- 2021-02-25
- 2021-03-04
-
2021-03-11
Dose 2 — Moderna
- 2021-03-11
-
2021-03-12
Survey response — days 1–6 daily, dose 2MedDRA: Decreased appetite — Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesFree text: Lack appetiteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-13
Survey response — days 1–6 daily, dose 2MedDRA: Feeling abnormal — Feeling: Good · Site: PainFree text: Awoke slight brain fog gone nowMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-14
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-26
- 2021-04-01
- 2021-04-08
- 2021-04-15
- 2021-04-22
-
2021-06-10
Survey response — 3 months, dose 2MedDRA: Dizziness, Inner ear disorder, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: A dizzying feeling comes and goes. PCP referred me to therapy, (waiting for call from them) as PCP suspected inner ear issue. · Healthcare visit (other): Saw PCP at annual health visit 6/9/21MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-06-10
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-06-21
-
2021-06-24
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-09-09
Survey response — 6 months, dose 2MedDRA: Brain scan abnormal, Cerebral atrophy, Memory impairment, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Short term memory lapses. Had a brain/ cranial scan MRI. Radiologist reports from scan noting atrophy. · Healthcare visit (other): There is a scheduled Tele visit with a neurologist 10/04/21MedDRA releases: 2024-11 · check-in free text available
-
2021-09-09
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-10
-
2021-10-25
Dose 3 — Moderna
-
2021-10-28
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-08
- 2021-11-22
- 2021-11-29
- 2021-12-06
- 2022-01-24
-
2022-06-22
Dose 4 — Moderna
-
2022-06-24
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Chills, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-06-25
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: Good · Site: PainFree text: No, feel great!MedDRA releases: 2024-11 · check-in free text available
- 2022-06-26
- 2022-06-27
- 2022-06-28
- 2022-06-29
- 2022-07-06
- 2022-07-13
- 2022-07-20
- 2022-07-27
- 2022-08-03
- 2022-09-21
-
2022-12-21
Survey response — 6 months, dose 4MedDRA: Cough, Nasal congestion, Pulmonary congestion, Sneezing — Feeling: Good · Be unable to do your normal daily activitiesFree text: Sneeze, cough, nasal and lung congestion.MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-11 | Moderna | |
| 2 | 2021-03-11 | Moderna | |
| 3 | 2021-10-25 | Moderna | No |
| 4 | 2022-06-22 | Moderna | No |
Call center
2 call center cases
1 successful · 1 unsuccessful
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Brain Fog
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Lack appetite
Systemic reaction (other): Awoke slight brain fog gone now
Release 9 — 3 months, dose 2
Symptoms: A dizzying feeling comes and goes. PCP referred me to therapy, (waiting for call from them) as PCP suspected inner ear issue.
Healthcare visit (other): Saw PCP at annual health visit 6/9/21
Release 9 — 6 months, dose 2
Symptoms: Short term memory lapses. Had a brain/ cranial scan MRI. Radiologist reports from scan noting atrophy.
Healthcare visit (other): There is a scheduled Tele visit with a neurologist 10/04/21
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): No, feel great!
Release 12 — 6 months, dose 4
Symptoms: Sneeze, cough, nasal and lung congestion.
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 | Unevaluable event | · | · | ✓ |
| SD | Brain scan abnormal | · | · | ✓ |
| SD | Cerebral atrophy | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Dizziness | ✓ | ✓ | ✓ |
| SD | Inner ear disorder | ✓ | ✓ | ✓ |
| SD | Memory impairment | · | · | ✓ |
| SD | Nasal congestion | · | · | ✓ |
| SD | Office visit | ✓ | ✓ | ✓ |
| SD | Pulmonary congestion | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SRO | Decreased appetite | ✓ | ✓ | ✓ |
| SRO | Feeling abnormal | ✓ | ✓ | ✓ |
| SRO | No adverse event | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release