468-18921-25914

3 vaccinations 6 coded responses 19 check-ins 6 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 125 / NY
Registered: 2021-02-25

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

Timeline

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

2021-02-15
Dose 1 — Moderna
2021-02-25
Registered in v-safe
2021-02-25
Health check-in — day 7, dose 1
Feeling: Fair · Site: Pain · Fever · None

Adult check-in
2021-03-01
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-17
Survey response — day 28, dose 1
MedDRA: Atrial fibrillation, Cystitis, Drug hypersensitivity, Hospitalisation, Kidney infection, Pulmonary oedema, SARS-CoV-2 test negative, Sepsis — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Bladder, kidney infection. Sepsis. Admitted 12 th March. Allergic reaction from zosyn. Fluid in lung. Afib. Covid infection, negative.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Report sent to call center — day 28, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-22
Survey response — day 35, dose 1
MedDRA: Bacterial infection, Cystitis, Sepsis, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Symptoms: Recovering from bacteria infection of bladder and sepsis. · Healthcare visit (other): Discharge today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Report sent to call center — day 35, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-24
Dose 2 — Moderna
2021-03-29
Survey response — days 1–6 daily, dose 2
MedDRA: Bladder disorder, Hospitalisation, Medical counselling, Office visit, Renal disorder, SARS-CoV-2 test negative, Sepsis — Feeling: Fair · Muscle or body aches · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Admitted 14 mar EMR. Bladder, kidney,sepsis diagnosed. Ertapenem Antibiotics administered. Follow 6 wks course. Treatment continue. Negative covid test. · Healthcare visit (other): Office visits and nurse care at home

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-30
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Bradykinesia — Feeling: Fair · Muscle or body aches

Free text: Weakness, slow in movements

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — day 7, dose 2
MedDRA: Asthenia, Bacterial infection, Medical counselling — Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Weakness slow movement. Getting Ertapenem Ive infusion daily dose for ecoli bacteria infection. · Healthcare visit (other): At home nurse visits. Physical therapist & Ive nurse, Dr visits at office.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Report sent to call center — day 7, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-07
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-14
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-21
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-29
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-05-07
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-09
Call 1 — Left Voicemail
2021-06-09
Call 1 — Left Voicemail
2021-06-09
Call 1 — Left Voicemail
2021-06-09
Call 1 — Left Voicemail
2021-06-23
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-09-22
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-10-30
Dose 3 — Moderna
2021-10-30
Survey response — day 0, dose 3
MedDRA: Asthenia — Feeling: Fair · Fatigue or tiredness

Free text: Weakness

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · None

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · None

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-15	Moderna
2	2021-03-24	Moderna
3	2021-10-30	Moderna	No

Call center

4 call center cases

4 unsuccessful

See the call center timeline

Free text

Release 5 — day 28, dose 1

2021-03-17

Symptoms: Bladder, kidney infection. Sepsis. Admitted 12 th March. Allergic reaction from zosyn. Fluid in lung. Afib. Covid infection, negative.

Release 6 — day 35, dose 1

2021-03-22

Symptoms: Recovering from bacteria infection of bladder and sepsis.

Healthcare visit (other): Discharge today

Release 6 — days 1–6 daily, dose 2

2021-03-29

Systemic reaction (other): Admitted 14 mar EMR. Bladder, kidney,sepsis diagnosed. Ertapenem Antibiotics administered. Follow 6 wks course. Treatment continue. Negative covid test.

Healthcare visit (other): Office visits and nurse care at home

2021-03-30

Systemic reaction (other): Weakness, slow in movements

Release 6 — day 7, dose 2

2021-03-31

Systemic reaction (other): Weakness slow movement. Getting Ertapenem Ive infusion daily dose for ecoli bacteria infection.

Healthcare visit (other): At home nurse visits. Physical therapist & Ive nurse, Dr visits at office.

Release 10 — day 0, dose 3

2021-10-30

Systemic reaction (other): Weakness

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	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Atrial fibrillation	✓	✓	✓
SD	Bacterial infection	✓	✓	✓
SD	Cystitis	✓	✓	✓
SD	Drug hypersensitivity	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Kidney infection	✓	✓	✓
SD	Pulmonary oedema	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Sepsis	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Bacterial infection	✓	✓	✓
SRO	Bladder disorder	✓	✓	✓
SRO	Bradykinesia	✓	✓	✓
SRO	Hospitalisation	✓	✓	✓
SRO	Renal disorder	✓	✓	✓
SRO	SARS-CoV-2 test negative	✓	✓	✓
SRO	Sepsis	✓	✓	✓

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