3X5-16137-61435

1 vaccination 8 coded responses 14 check-ins 8 free-text entries 7 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 520 / IA
Registered: 2021-03-30

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

2021-03-30
Registered in v-safe
2021-03-30
Dose 1 — Moderna
2021-03-30
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Nausea

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-01
Survey response — days 1–6 daily, dose 1
MedDRA: Emergency care, Hospitalisation, Respiratory failure — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Systemic reaction (other): In hospital since early this morning on continuous oxygen, meds etc due to respiratory failure around 5am this morning. It came out of nowhere and Im being monitored closely in the hospital. · Healthcare visit (other): 911 Ambulance ride to hospital

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-03
Survey response — days 1–6 daily, dose 1
MedDRA: Hospitalisation, Pulmonary oedema, Reaction to preservatives — Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Pulmonary edema and chf hospitalized due to this being a reaction of the vaccination

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-04
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-05
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Poor · Fever · Chills, Joint pains, Muscle or body aches, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: Shortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Health check-in — day 7, dose 1
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-13
Survey response — day 14, dose 1
MedDRA: Amnesia, Cardiac failure congestive, Dyspnoea, Hospitalisation, Hypervolaemia, Oxygen therapy, Vision blurred — Feeling: Fair · Be unable to work, 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: Shortness of breath. Fluid overload on my lungs causing Congestive Heart Failure and was in the hospital for two and a half days. I am now on oxygen because my lungs are so damaged. I also have blurry vision and severe memory loss.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Report sent to call center — day 14, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-20
Survey response — day 21, dose 1
MedDRA: Dyspnoea, Inflammation, Oxygen consumption — Feeling: Fair · Be unable to work, 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: Shortness of breath off and on, whole body inflammation and now Im on oxygen at night always and during the day as needed. Which lately is a lot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Report sent to call center — day 21, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-27
Survey response — day 28, dose 1
MedDRA: COVID-19, Dyspnoea, Inflammation, Oxygen therapy, Pain, Stress, Ulcer — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, 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: Shortness of breath during times of hot weather or humidity. Also during times of severe stress. Also during times when I hade a Covid relapse and I get SOB, inflammation on entire body, sores, on oxygen at night and as needed during the day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Report sent to call center — day 28, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-05
Survey response — day 35, dose 1
MedDRA: Pulmonary congestion — Feeling: Poor · Be unable to work or attend school, 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: Very bad lung congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Report sent to call center — day 35, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-12
Health check-in — day 42, dose 1
Feeling: Fair

Adult check-in
2021-06-09
Call 1 — Left Voicemail
2021-06-29
Survey response — 3 months, dose 1
MedDRA: Anger, Cognitive disorder, Dysgraphia, Feeling of despair, Helplessness, Inflammation, Memory impairment, Reading disorder — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: inflammation,my brain doesnt work the way it used causing forgetful ness, outbursts,Not reading or spelling rights I feel helpless because instead of getting better it gets worse & I thought I was being a responsible AMERICAN CITIZEN!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-29
Report sent to call center — 3 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-01
Call 1 — Left Voicemail
2021-09-28
Health check-in — 6 months, dose 1
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-30	Moderna

Call center

7 call center cases

7 unsuccessful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 1

2021-04-01

Systemic reaction (other): In hospital since early this morning on continuous oxygen, meds etc due to respiratory failure around 5am this morning. It came out of nowhere and Im being monitored closely in the hospital.

Healthcare visit (other): 911 Ambulance ride to hospital

2021-04-03

Systemic reaction (other): Pulmonary edema and chf hospitalized due to this being a reaction of the vaccination

2021-04-05

Systemic reaction (other): Shortness of breath

Release 7 — day 14, dose 1

2021-04-13

Symptoms: Shortness of breath. Fluid overload on my lungs causing Congestive Heart Failure and was in the hospital for two and a half days. I am now on oxygen because my lungs are so damaged. I also have blurry vision and severe memory loss.

Release 7 — day 21, dose 1

2021-04-20

Symptoms: Shortness of breath off and on, whole body inflammation and now Im on oxygen at night always and during the day as needed. Which lately is a lot.

Release 8 — day 28, dose 1

2021-04-27

Symptoms: Shortness of breath during times of hot weather or humidity. Also during times of severe stress. Also during times when I hade a Covid relapse and I get SOB, inflammation on entire body, sores, on oxygen at night and as needed during the day.

Release 8 — day 35, dose 1

2021-05-05

Symptoms: Very bad lung congestion

Release 9 — 3 months, dose 1

2021-06-29

Symptoms: inflammation,my brain doesnt work the way it used causing forgetful ness, outbursts,Not reading or spelling rights I feel helpless because instead of getting better it gets worse & I thought I was being a responsible AMERICAN CITIZEN!

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	Emergency care	✓	✓	✓
SD	Amnesia	✓	✓	✓
SD	Anger	✓	✓	✓
SD	Cardiac failure congestive	✓	✓	✓
SD	Cognitive disorder	✓	·	✓
SD	COVID-19	·	·	✓
SD	Dysgraphia	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Feeling of despair	○	✓	○
SD	Helplessness	✓	·	✓
SD	Hospitalisation	✓	✓	✓
SD	Hypervolaemia	✓	✓	✓
SD	Inflammation	✓	✓	✓
SD	Memory impairment	✓	✓	✓
SD	Oxygen consumption	○	✓	○
SD	Oxygen therapy	✓	✓	✓
SD	Pain	✓	✓	○
SD	Pulmonary congestion	✓	✓	✓
SD	Reading disorder	✓	✓	✓
SD	Stress	✓	✓	○
SD	Ulcer	·	·	✓
SD	Vision blurred	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Hospitalisation	✓	✓	✓
SRO	Pulmonary oedema	✓	✓	✓
SRO	Reaction to preservatives	✓	✓	✓
SRO	Respiratory failure	✓	✓	✓

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