4LZ-19580-89185

2 vaccinations 8 coded responses 20 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 120 / NY
Registered: 2021-01-30

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

2020-06-02
Call 2 — Left Voicemail
2021-01-29
Dose 1 — Moderna
2021-01-30
Registered in v-safe
2021-01-30
Survey response — days 1–6 daily, dose 1
MedDRA: Photopsia, Specialist consultation, Vitreous floaters — Feeling: Good · Site: Pain · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Two hours after I had shot I started getting floaters and lightning bolts in my eye. I saw Ophthalmologist today and have Posterior Vitreous Detachment. It may be coincidental but thought I would mention it. · Healthcare visit (other): Ophthalmologists Office

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-02
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Good

Free text: This may relate to my cancer but the top of the head is very sore when touched.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-05
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-26
Dose 2 — Moderna
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling abnormal — Feeling: Fair · Site: Pain · Joint pains, Fatigue or tiredness

Free text: Fogginess the day after the shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Headache — Feeling: Fair · Chills, Headache, Fatigue or tiredness

Free text: Soreness in back of head on right side.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Blood urine present, Urinary tract infection — Feeling: Fair

Free text: UTI with a lot of blood.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — days 1–6 daily, dose 2
MedDRA: Haemorrhage, Urinary tract infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: Urinary tract infection with bleeding

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — day 7, dose 2
MedDRA: Hospitalisation, Urinary tract infection — Feeling: Fair

Free text: In hospital with complications from a urinary tract infection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — day 14, dose 2
MedDRA: Haemorrhage urinary tract, Hospitalisation, Urinary tract infection — Feeling: Good · Be unable to do your normal daily activities

Free text: Urinary tract infection with bleeding. I ended up in the hospital for three days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 28, dose 2
Feeling: Good

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

Adult check-in
2021-04-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-27
Call 1 — Requested Callback
2021-05-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-29	Moderna
2	2021-02-26	Moderna

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-01-30

Systemic reaction (other): Two hours after I had shot I started getting floaters and lightning bolts in my eye. I saw Ophthalmologist today and have Posterior Vitreous Detachment. It may be coincidental but thought I would mention it.

Healthcare visit (other): Ophthalmologists Office

2021-02-02

Systemic reaction (other): This may relate to my cancer but the top of the head is very sore when touched.

Release 4 — days 1–6 daily, dose 2

2021-02-28

Systemic reaction (other): Fogginess the day after the shot.

2021-03-02

Systemic reaction (other): Soreness in back of head on right side.

Release 5 — days 1–6 daily, dose 2

2021-03-03

Systemic reaction (other): UTI with a lot of blood.

2021-03-04

Systemic reaction (other): Urinary tract infection with bleeding

Release 5 — day 7, dose 2

2021-03-05

Systemic reaction (other): In hospital with complications from a urinary tract infection.

Release 5 — day 14, dose 2

2021-03-12

Symptoms: Urinary tract infection with bleeding. I ended up in the hospital for three days.

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	Specialist consultation	✓	✓	✓
SD	Haemorrhage urinary tract	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Urinary tract infection	✓	✓	✓
SRO	Blood urine present	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Haemorrhage	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Hospitalisation	✓	✓	✓
SRO	Photopsia	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Urinary tract infection	✓	✓	✓
SRO	Vitreous floaters	✓	✓	✓

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