56J-33121-82627

3 vaccinations 7 coded responses 29 check-ins 7 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 786 / TX
Registered: 2021-03-09

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-03-02
Dose 1 — Moderna
2021-03-09
Registered in v-safe
2021-03-09
Survey response — day 7, dose 1
MedDRA: Fatigue, Pain in extremity — Feeling: Good

Free text: The day of my vaccination I felt tired. The day after my arm was mildly sore

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Survey response — day 14, dose 1
MedDRA: Blood pressure increased, Confusional state, Depressed level of consciousness, Emergency care, Headache, Seizure — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Taken to the ER on 3/15 with a suspected TIA. The Doctor & Neurologist now think it was a seizure (confusion, loss of awareness, increased blood pressure and low grade headache.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
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)
2021-03-23
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-30
Dose 2 — Moderna
2021-03-30
Health check-in — day 0, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-01
Survey response — days 1–6 daily, dose 2
MedDRA: Eye pain — Feeling: Good · Headache

Free text: Pain Im my left eye

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-04-06
Health check-in — day 7, dose 2
Feeling: Good · Headache

Adult check-in
2021-04-20
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-27
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-11
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-01
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-28
Survey response — 6 months, dose 2
MedDRA: Breast calcifications, Tinnitus, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Constant tinnitus, calcifications in left breast · Healthcare visit (other): ENT Office visit scheduled

MedDRA releases: 2024-11 · check-in free text available
2021-09-28
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-10-01
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-26
Dose 3 — Moderna
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-11-04
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-09
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-16
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-25
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-07
Survey response — day 42, dose 3
MedDRA: Intraductal proliferative breast lesion, Surgery — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: New health condition: DCIS · Healthcare visit (other): Out patient surgical biopsy

MedDRA releases: 2024-11 · check-in free text available
2021-12-07
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-09
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-25
Survey response — 3 months, dose 3
MedDRA: Breast cancer, Intraductal proliferative breast lesion, Office visit, Pre-existing disease, Surgery — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Confirmed DCIS INSITU, stage 0, breast cancer in one breast · Healthcare visit (other): Out patient surgery, dr vists

MedDRA releases: 2024-11 · check-in free text available
2022-01-25
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-01-27
Call 1 — Left Voicemail
2022-04-29
Survey response — 6 months, dose 3
MedDRA: Intraductal proliferative breast lesion, Mastectomy, Surgery — 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

Free text: Symptoms: Had a single mastectomy because of DCIS INSITU stage zero breast cancer · Healthcare visit (other): Outpatient surgery

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Report sent to call center — 6 months, dose 3
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)
2022-05-03
Call 1 — Left Voicemail
2022-10-28
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-02	Moderna
2	2021-03-30	Moderna
3	2021-10-26	Moderna	No

Call center

5 call center cases

3 successful · 2 unsuccessful

See the call center timeline

Free text

Release 5 — day 7, dose 1

2021-03-09

Systemic reaction (other): The day of my vaccination I felt tired. The day after my arm was mildly sore

Release 5 — day 14, dose 1

2021-03-16

Symptoms: Taken to the ER on 3/15 with a suspected TIA. The Doctor & Neurologist now think it was a seizure (confusion, loss of awareness, increased blood pressure and low grade headache.

Release 6 — days 1–6 daily, dose 2

2021-04-01

Systemic reaction (other): Pain Im my left eye

Release 9 — 6 months, dose 2

2021-09-28

Symptoms: Constant tinnitus, calcifications in left breast

Healthcare visit (other): ENT Office visit scheduled

Release 10 — day 42, dose 3

2021-12-07

Symptoms: New health condition: DCIS

Healthcare visit (other): Out patient surgical biopsy

Release 11 — 3 months, dose 3

2022-01-25

Symptoms: Confirmed DCIS INSITU, stage 0, breast cancer in one breast

Healthcare visit (other): Out patient surgery, dr vists

Release 11 — 6 months, dose 3

2022-04-29

Symptoms: Had a single mastectomy because of DCIS INSITU stage zero breast cancer

Healthcare visit (other): Outpatient surgery

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	Office visit	·	·	✓
HCVO	Surgery	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Blood pressure increased	✓	✓	✓
SD	Breast calcifications	·	·	✓
SD	Breast cancer	·	·	✓
SD	Confusional state	✓	✓	✓
SD	Depressed level of consciousness	✓	✓	✓
SD	Emergency care	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Intraductal proliferative breast lesion	·	·	✓
SD	Mastectomy	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Seizure	✓	✓	✓
SD	Tinnitus	·	·	✓
SRO	Eye pain	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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