6BB-25409-27784

2 vaccinations 11 coded responses 23 check-ins 11 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 776 / TX
Registered: 2021-03-25

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

2021-03-25
Registered in v-safe
2021-03-25
Dose 1 — Moderna
2021-03-25
Health check-in — day 0, dose 1
Feeling: Poor · Site: Pain · Muscle or body aches, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-03-26
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Pain in my right leg around the shin same as when I had CoVid in December

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Joint pains, Nausea, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-03-28
Survey response — days 1–6 daily, dose 1
MedDRA: Back pain, Painful respiration — Feeling: Fair · Site: Pain · Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: Upper back on left side of my body hurts when I try to take a deep breath.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — days 1–6 daily, dose 1
MedDRA: Breast pain — Feeling: Good · Muscle or body aches

Free text: Occasional pain in my breast

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — day 7, dose 1
MedDRA: Lymph node pain — Feeling: Good · Muscle or body aches

Free text: Lymph nodes in breast have been hurting since day after 1st Madersma shots

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-15
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-22
Dose 2 — Moderna
2021-04-22
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-22
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · None

Adult check-in
2021-04-24
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Some chest pain on right side

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema — Feeling: Fair · Site: Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Flat red dots on my leg

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Survey response — days 1–6 daily, dose 2
MedDRA: Memory impairment — Feeling: Fair · Site: Redness, Swelling, Itching · Muscle or body aches

Free text: Forgetfulness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Joint pains

Adult check-in
2021-04-30
Health check-in — day 7, dose 2
Feeling: Good · Site: Swelling, Itching · None

Adult check-in
2021-05-08
Survey response — day 14, dose 2
MedDRA: Arthralgia, Pre-existing disease, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: It is an arthritic area, my hip, that is really hurting me today. · Healthcare visit (other): I will go to the doctor this week.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-08
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-20
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-28
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-07-22
Survey response — 3 months, dose 2
MedDRA: Fatigue, Sinus disorder, Underweight — Feeling: Good · Be unable to do your normal daily activities

Free text: Fatigue the last week. Felt like depression. I am still underweight. 97-100 lbs.Sinus problem probably due to allergies. I will try to get pillow covers for allergies and also received an air purifier yesterday.

MedDRA releases: 2024-11 · check-in free text available
2021-10-23
Survey response — 6 months, dose 2
MedDRA: Mammogram abnormal, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Suspicious area on October mammogram. Doctor ordered stereotactic biopsy. Will have it on Nov 4 · Healthcare visit (other): Had mammogram and Ultrasound at the Medical Center in (b)(6).

MedDRA releases: 2024-11 · check-in free text available
2021-10-23
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-26
Call 1 — Left Voicemail
2021-11-01
Call 2 — Left Voicemail
2022-04-22
Survey response — 12 months, dose 2
MedDRA: Breast calcifications, COVID-19, Mammogram abnormal, Office visit, Weight decreased — Feeling: Good · Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: Have had substantial weight loss since December of 2020 when I contracted Covid. In December, 2021, I was sent for a cat scan & stereotactic breast biopsy, since mammogram showed an area of concern on left breast. They will keep watch. · Healthcare visit (other): Had weight loss and breast calcification checked out.

MedDRA releases: 2024-11 · check-in free text available
2022-04-22
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-04-25
Call 1 — Left Voicemail
2022-04-25
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-25	Moderna
2	2021-04-22	Moderna

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-26

Systemic reaction (other): Pain in my right leg around the shin same as when I had CoVid in December

2021-03-28

Systemic reaction (other): Upper back on left side of my body hurts when I try to take a deep breath.

2021-03-31

Systemic reaction (other): Occasional pain in my breast

Release 6 — day 7, dose 1

2021-04-01

Systemic reaction (other): Lymph nodes in breast have been hurting since day after 1st Madersma shots

Release 7 — days 1–6 daily, dose 2

2021-04-24

Systemic reaction (other): Some chest pain on right side

Release 8 — days 1–6 daily, dose 2

2021-04-26

Systemic reaction (other): Flat red dots on my leg

2021-04-27

Systemic reaction (other): Forgetfulness

Release 8 — day 14, dose 2

2021-05-08

Symptoms: It is an arthritic area, my hip, that is really hurting me today.

Healthcare visit (other): I will go to the doctor this week.

Release 9 — 3 months, dose 2

2021-07-22

Symptoms: Fatigue the last week. Felt like depression. I am still underweight. 97-100 lbs.Sinus problem probably due to allergies. I will try to get pillow covers for allergies and also received an air purifier yesterday.

Release 10 — 6 months, dose 2

2021-10-23

Symptoms: Suspicious area on October mammogram. Doctor ordered stereotactic biopsy. Will have it on Nov 4

Healthcare visit (other): Had mammogram and Ultrasound at the Medical Center in (b)(6).

redacted (b)(6)

Release 11 — 12 months, dose 2

2022-04-22

Symptoms: Have had substantial weight loss since December of 2020 when I contracted Covid. In December, 2021, I was sent for a cat scan & stereotactic breast biopsy, since mammogram showed an area of concern on left breast. They will keep watch.

Healthcare visit (other): Had weight loss and breast calcification checked out.

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	Breast calcifications	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Unevaluable event	✓	✓	✓
HCVO	Weight decreased	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Fatigue	·	·	✓
SD	Mammogram abnormal	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Sinus disorder	·	·	✓
SD	Underweight	·	·	✓
SD	Weight decreased	·	·	✓
SRO	Back pain	✓	✓	✓
SRO	Breast pain	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Lymph node pain	✓	✓	✓
SRO	Memory impairment	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Painful respiration	✓	✓	✓

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