6CX-33190-87652

3 vaccinations 6 coded responses 31 check-ins 6 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 791 / TX
Registered: 2021-01-10

Relationship: Self
Race: Black or African American
Ethnicity: N/A

Timeline

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

2021-01-09
Dose 1 — Moderna
2021-01-10
Registered in v-safe
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Itching · Nausea

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Itching · None

Adult check-in
2021-01-12
Survey response — days 1–6 daily, dose 1
MedDRA: Epistaxis — Feeling: Fair · Site: Itching

Free text: Don't know if its related, but i had a severe nose bleed yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Survey response — days 1–6 daily, dose 1
MedDRA: Epistaxis — Feeling: Fair · Site: Pain · Headache, Nausea

Free text: Had another nose bleed today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache

Adult check-in
2021-01-16
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-30
Survey response — day 21, dose 1
MedDRA: Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Was diagnosed with AFib. Had nothing to do with the vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-06
Dose 2 — Moderna
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Nausea

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Itching · Headache, Nausea

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Itching · Headache, Nausea

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-13
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-21
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-02-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-13
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-20
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-10
Survey response — 3 months, dose 2
MedDRA: Atrial fibrillation, Dyspnoea, Heart rate increased, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Too fast heart beat. ( AFIB) Breathing problems. Probably not the fault of the vaccine, but i have had a number of problems

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Call 1 — Left Voicemail
2021-08-07
Survey response — 6 months, dose 2
MedDRA: Dyspnoea, Fatigue, Pulmonary fibrosis — Feeling: Fair · Be unable to do your normal daily activities

Free text: Was diagnosed with Pulmonary fibrosis. Had shortness of breath and tired easily. I don't believe it was caused by the vaccine, but think it may have brought it to the surface.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-26
Dose 3 — Moderna
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Itching · Headache

Adult check-in
2021-11-04
Survey response — day 7, dose 3
MedDRA: Adverse reaction — Feeling: Good · Headache

Free text: Have had several of these symptoms, dont know if they related to the vaccine.

MedDRA releases: 2024-11 · check-in free text available
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
2021-11-24
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-07
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-27
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-04-26
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-10-26
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-09	Moderna
2	2021-02-06	Moderna
3	2021-10-26	Moderna	No

Call center

1 call center case

1 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-12

Systemic reaction (other): Don't know if its related, but i had a severe nose bleed yesterday

2021-01-13

Systemic reaction (other): Had another nose bleed today

Release 3 — day 21, dose 1

2021-01-30

Symptoms: Was diagnosed with AFib. Had nothing to do with the vaccine

Release 8 — 3 months, dose 2

2021-05-10

Symptoms: Too fast heart beat. ( AFIB) Breathing problems. Probably not the fault of the vaccine, but i have had a number of problems

Release 9 — 6 months, dose 2

2021-08-07

Symptoms: Was diagnosed with Pulmonary fibrosis. Had shortness of breath and tired easily. I don't believe it was caused by the vaccine, but think it may have brought it to the surface.

Release 10 — day 7, dose 3

2021-11-04

Systemic reaction (other): Have had several of these symptoms, dont know if they related to the vaccine.

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	Atrial fibrillation	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	·	✓
SD	Heart rate increased	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pulmonary fibrosis	✓	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Epistaxis	✓	✓	✓
SRO	Unevaluable event	○	○	○

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