4QF-29193-91256
4 vaccinations
4 coded responses
50 check-ins
4 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 630 / MO
- Registered
- 2021-02-03
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-03
Registered in v-safe
-
2021-02-03
Dose 1 — Moderna
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-17
- 2021-02-24
-
2021-03-02
Dose 2 — Moderna
-
2021-03-02
Survey response — day 0, dose 2MedDRA: Pain — Feeling: Good · Site: PainFree text: Hurts to raise arm that received shotMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-03
Survey response — days 1–6 daily, dose 2MedDRA: Pain in extremity — Feeling: Good · Muscle or body aches, Fatigue or tirednessFree text: Can now raise the arm without pain- just some discomfortMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-04
- 2021-03-05
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
- 2021-04-06
- 2021-04-13
- 2021-06-01
- 2021-08-31
-
2021-10-27
Dose 3 — Moderna
- 2021-10-27
-
2021-10-28
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-10
- 2021-11-17
- 2021-11-24
- 2021-12-01
- 2021-12-08
-
2022-01-26
Survey response — 3 months, dose 3MedDRA: Dyspnoea, Mitral valve incompetence, Office visit, SARS-CoV-2 test negative, SARS-CoV-2 test positive — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Shortness of breath due to Mitral valve regurgitation. Had covid test at (b)(6) Acute care. Positive. Had EKG ALL ON 1/10/22. 1/18/22 had echocardiogram complete. 1/21/22 had covid test at (b)(6) hospital- negative.MedDRA releases: 2024-11 · check-in free text available
-
2022-01-26
Report sent to call center — 3 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-02-10
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-04-27
Survey response — 6 months, dose 3MedDRA: Cardiac assistance device user, Cardiomegaly, Catheterisation cardiac abnormal, Coronary arterial stent insertion, Coronary artery disease, Mitral valve incompetence, Respiratory symptom, SARS-CoV-2 test positive — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, HospitalizationFree text: Symptoms: Coronary heart disease. Discovered 1/10/22. Enlarged heart. Mitral valve not closing properly. Covid test that day was positive. But looking back, i had the shortness of breath symptoms in the fall of 2021 that progressively got worse. · Healthcare visit (other): Ih hospital had cardiac catherization and eventually had 3 stents put in. Wearing a portable defribulator until pacemsker/defribulator can be implantedMedDRA releases: 2024-11 · check-in free text available
-
2022-04-27
Report sent to call center — 6 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Hospitalization · 1 call case(s)
-
2022-04-28
Call successfulNot applicable - Accidental Reporting
-
2022-05-13
Dose 4 — Moderna
- 2022-05-19
- 2022-05-20
- 2022-05-27
- 2022-06-03
- 2022-06-10
- 2022-06-18
- 2022-06-24
- 2022-08-12
- 2022-11-11
- 2023-05-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-03 | Moderna | |
| 2 | 2021-03-02 | Moderna | |
| 3 | 2021-10-27 | Moderna | No |
| 4 | 2022-05-13 | Moderna | No |
Call center
2 call center cases
2 successful
Free text
Release 4 — day 0, dose 2
Systemic reaction (other): Hurts to raise arm that received shot
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Can now raise the arm without pain- just some discomfort
Release 11 — 3 months, dose 3
Symptoms: Shortness of breath due to Mitral valve regurgitation. Had covid test at (b)(6) Acute care. Positive. Had EKG ALL ON 1/10/22. 1/18/22 had echocardiogram complete. 1/21/22 had covid test at (b)(6) hospital- negative.
redacted (b)(6)
Release 11 — 6 months, dose 3
Symptoms: Coronary heart disease. Discovered 1/10/22. Enlarged heart. Mitral valve not closing properly. Covid test that day was positive. But looking back, i had the shortness of breath symptoms in the fall of 2021 that progressively got worse.
Healthcare visit (other): Ih hospital had cardiac catherization and eventually had 3 stents put in. Wearing a portable defribulator until pacemsker/defribulator can be implanted
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 | Cardiac assistance device user | · | · | ✓ |
| HCVO | Catheterisation cardiac abnormal | · | · | ✓ |
| HCVO | Coronary arterial stent insertion | · | · | ✓ |
| SD | Cardiomegaly | · | · | ✓ |
| SD | Coronary artery disease | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Mitral valve incompetence | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Respiratory symptom | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release