4XU-67132-56950

3 vaccinations 12 coded responses 24 check-ins 12 free-text entries 3 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 787 / TX
Registered: 2021-01-01

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

2020-12-30
Dose 1 — Moderna
2021-01-01
Registered in v-safe
2021-01-01
Survey response — days 1–6 daily, dose 1
MedDRA: Breast pain — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea

Free text: Sharp breast pain now resolved

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-03
Survey response — days 1–6 daily, dose 1
MedDRA: Abnormal dreams — Feeling: Good

Free text: Vivid dreams x 3 nights

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Diarrhea, Abdominal pain

Adult check-in
2021-01-05
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Myalgia, Pain in extremity — Feeling: Fair · Site: Pain · Headache

Free text: Arm pain returned as a muscle ache this afternoon. The headache is sporadic spamming type pain in the upper back portion of the head.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-06
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-13
Survey response — day 14, dose 1
MedDRA: Injection site pain — Feeling: Good

Free text: Injection site pain returned x 1 day yesterday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-20
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-27
Dose 2 — Moderna
2021-01-27
Survey response — day 0, dose 2
MedDRA: Tinnitus — Feeling: Fair · Site: Pain · Nausea · Be unable to do your normal daily activities

Free text: Tinnitus- so loud!!!!!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — days 1–6 daily, dose 2
MedDRA: Tinnitus — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Tinnitus

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Survey response — days 1–6 daily, dose 2
MedDRA: Tinnitus — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Tinnitus

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site erythema, Injection site warmth — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Red war circular areas about 2 inches in diameter, about 3-4 inches from injection site. Not tracking.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Survey response — days 1–6 daily, dose 2
MedDRA: Hypotension — Feeling: Fair · Site: Redness, Itching · Fatigue or tiredness · 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

Free text: Hypotension 70s/50s bright up with fluids and caffeine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Report sent to call center — days 1–6 daily, dose 2
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)
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-03
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-24
Health check-in — day 28, dose 2
Feeling: Good

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

Adult check-in
2021-03-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-28
Survey response — 3 months, dose 2
MedDRA: Hypertension — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Hypertension is difficult to control

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-11
Call 1 — Left Voicemail
2021-07-28
Survey response — 6 months, dose 2
MedDRA: Hypoacusis, Urticaria — Feeling: Good · 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: Loss of 40% hearing. Full body hives x 3 weeks.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-28
Report sent to call center — 6 months, dose 2
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)
2021-08-04
Call 1 — Left Voicemail
2021-12-15
Dose 3 — Moderna
2022-01-27
Survey response — 12 months, dose 2
MedDRA: Pregnancy, Pyrexia, Self-medication — Feeling: Good

Free text: Pregnancy. Boosted at 11 weeks with Moderna and had a 102-103 fever x 48 hours. Tylenol helped.

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-30	Moderna
2	2021-01-27	Moderna
3	2021-12-15	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-31	Unsuccessful
2021-04-28	Unsuccessful
2021-07-28	Unsuccessful

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-01

Systemic reaction (other): Sharp breast pain now resolved

2021-01-03

Systemic reaction (other): Vivid dreams x 3 nights

2021-01-05

Systemic reaction (other): Arm pain returned as a muscle ache this afternoon. The headache is sporadic spamming type pain in the upper back portion of the head.

Release 1 — day 14, dose 1

2021-01-13

Symptoms: Injection site pain returned x 1 day yesterday.

Release 2 — day 0, dose 2

2021-01-27

Systemic reaction (other): Tinnitus- so loud!!!!!

Release 2 — days 1–6 daily, dose 2

2021-01-28

Systemic reaction (other): Tinnitus

Release 3 — days 1–6 daily, dose 2

2021-01-29

Systemic reaction (other): Tinnitus

2021-01-30

Systemic reaction (other): Red war circular areas about 2 inches in diameter, about 3-4 inches from injection site. Not tracking.

2021-01-31

Systemic reaction (other): Hypotension 70s/50s bright up with fluids and caffeine

Release 8 — 3 months, dose 2

2021-04-28

Symptoms: Hypertension is difficult to control

Release 9 — 6 months, dose 2

2021-07-28

Symptoms: Loss of 40% hearing. Full body hives x 3 weeks.

Release 11 — 12 months, dose 2

2022-01-27

Symptoms: Pregnancy. Boosted at 11 weeks with Moderna and had a 102-103 fever x 48 hours. Tylenol helped.

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
SD	Hypertension	✓	✓	✓
SD	Hypoacusis	✓	·	✓
SD	Injection site pain	✓	✓	✓
SD	Pregnancy	·	·	✓
SD	Pyrexia	·	·	✓
SD	Self-medication	·	·	✓
SD	Urticaria	✓	·	✓
SRO	Abnormal dreams	✓	✓	✓
SRO	Breast pain	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Hypotension	✓	✓	✓
SRO	Injection site erythema	✓	✓	✓
SRO	Injection site warmth	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Tinnitus	✓	✓	✓

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