3UX-21924-55915

4 vaccinations 8 coded responses 33 check-ins 7 free-text entries 7 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 783 / TX
Registered: 2021-02-07

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

Timeline

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

2021-01-08
Dose 1 — Moderna
2021-02-05
Dose 2 — Moderna
2021-02-07
Registered in v-safe
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-08
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-06
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-28
Dose 3 — Moderna
2021-10-28
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Office visit, Urinary tract infection — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Uninary tract infection · Healthcare visit (other): Dr office for UTI

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-04
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-04
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-11-11
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-18
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-25
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-02
Survey response — day 35, dose 3
MedDRA: Headache, Sinus disorder — Feeling: Fair

Free text: Having some head aches but feel sure it is related to weather change sinus passages are raw.

MedDRA releases: 2024-11 · check-in free text available
2021-12-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-27
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-04
Dose 4 — Moderna
2022-04-18
Survey response — day 14, dose 4
MedDRA: Atrial flutter, Emergency care — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Lasr Saturday I experienced an Atrial flutter which I have never experienced before and spent several hours in emergency.

MedDRA releases: 2024-11 · check-in free text available
2022-04-18
Report sent to call center — day 14, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-25
Survey response — day 21, dose 4
MedDRA: Blood pressure fluctuation, Heart rate decreased, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: A low heart rate and high and low blood pressure · Healthcare visit (other): Doctor's office

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Report sent to call center — day 21, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-25
Call 1 — Left Voicemail
2022-04-26
Call successful
Participant prefers to complete VAERS report online
2022-04-26
Call successful
Participant prefers to complete VAERS report online
2022-05-02
Survey response — day 28, dose 4
MedDRA: Blood pressure abnormal, Heart rate irregular, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Irregular blood pressure and heart rate · Healthcare visit (other): Dr office

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Report sent to call center — day 28, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-03
Call 1 — Left Voicemail
2022-05-09
Survey response — day 35, dose 4
MedDRA: Blood pressure fluctuation, Heart rate abnormal — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Fluctuating blood pressure and heart rate

MedDRA releases: 2024-11 · check-in free text available
2022-05-09
Report sent to call center — day 35, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-10
Call 1 — Left Voicemail
2022-05-13
Call successful
Participant prefers to complete VAERS report online
2022-05-13
Call successful
Participant prefers to complete VAERS report online
2022-05-16
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-07-06
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-03
Survey response — 6 months, dose 4
MedDRA: Heart rate irregular — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Still having episodes of irregular heartbeat and symptoms that go with it.

MedDRA releases: 2024-11 · check-in free text available
2022-10-03
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-10-04
Call 1 — Left Voicemail
2022-10-04
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-04
Survey response — 12 months, dose 4
MedDRA: Heart rate irregular, Malaise — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11
2023-04-04
Report sent to call center — 12 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2023-04-05
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-08	Moderna
2	2021-02-05	Moderna
3	2021-10-28	Moderna	No
4	2022-04-04	Moderna	No

Call center

7 call center cases

6 successful · 1 unsuccessful

See the call center timeline

Free text

Release 10 — days 1–6 daily, dose 3

2021-11-03

Systemic reaction (other): Uninary tract infection

Healthcare visit (other): Dr office for UTI

Release 10 — day 35, dose 3

2021-12-02

Symptoms: Having some head aches but feel sure it is related to weather change sinus passages are raw.

Release 11 — day 14, dose 4

2022-04-18

Symptoms: Lasr Saturday I experienced an Atrial flutter which I have never experienced before and spent several hours in emergency.

Release 11 — day 21, dose 4

2022-04-25

Symptoms: A low heart rate and high and low blood pressure

Healthcare visit (other): Doctor's office

Release 11 — day 28, dose 4

2022-05-02

Symptoms: Irregular blood pressure and heart rate

Healthcare visit (other): Dr office

Release 11 — day 35, dose 4

2022-05-09

Symptoms: Fluctuating blood pressure and heart rate

Release 12 — 6 months, dose 4

2022-10-03

Symptoms: Still having episodes of irregular heartbeat and symptoms that go with it.

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	Urinary tract infection	·	·	✓
SD	Atrial flutter	·	·	✓
SD	Blood pressure abnormal	·	·	✓
SD	Blood pressure fluctuation	·	·	✓
SD	Emergency care	·	·	✓
SD	Headache	·	·	✓
SD	Heart rate abnormal	·	·	✓
SD	Heart rate decreased	·	·	✓
SD	Heart rate irregular	·	·	✓
SD	Malaise	·	·	✓
SD	Sinus disorder	·	·	✓
SRO	Urinary tract infection	·	·	✓

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