6DR-11193-52057

3 vaccinations 16 coded responses 38 check-ins 16 free-text entries 1 call case

Sex: Female
Age at first dose: 36-40
ZIP prefix: 760 / TX
Registered: 2021-03-04

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

FBU-14912-02304 Child or adolescent in my care · Female · 2021-11-05

F55-23805-53562 Child or adolescent in my care · Female · 2021-11-05

Timeline

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

2021-03-04
Registered in v-safe
2021-03-04
Dose 1 — Moderna
2021-03-04
Health check-in — day 0, dose 1
Feeling: Fair · Headache, Muscle or body aches

Adult check-in
2021-03-05
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Poor · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Im started menstruation cycle today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Poor · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Im on my menstrual period now.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 1
MedDRA: Menstruation normal, Unevaluable event — Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Free text: Im on my menstrual period

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Free text: Im on my menstrual period.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — days 1–6 daily, dose 1
MedDRA: Menstruation normal — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Im on my menstrual period.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — day 7, dose 1
MedDRA: Unevaluable event — Feeling: Fair · Fatigue or tiredness

Free text: Im on my menstrual period.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-01
Dose 2 — Moderna
2021-04-01
Survey response — day 0, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Im on my menstrual cycle.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness

Free text: Im on my menstrual cycle

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea

Free text: I am on my menstrual cycle.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Free text: I am on my menstrual period.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-08
Survey response — day 7, dose 2
MedDRA: Oropharyngeal pain — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Soar throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — day 14, dose 2
MedDRA: Cough, Ear pain, Headache, Oropharyngeal pain — Feeling: Fair

Free text: A persistent cough and soar throat and ear pain as well as headaches.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Survey response — day 21, dose 2
MedDRA: Hypoaesthesia — Feeling: Poor

Free text: Numbness in left leg and feet.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Survey response — day 28, dose 2
MedDRA: Headache — Feeling: Fair

Free text: Headache and menstrual period.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-05-13
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
2021-09-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-06
Dose 3 — Moderna
2021-11-06
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

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

Adult check-in
2021-11-13
Health check-in — day 7, dose 3
Feeling: Fair · Headache

Adult check-in
2021-11-20
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-04
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-11
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-18
Survey response — day 42, dose 3
MedDRA: Ear infection — Feeling: Fair

Free text: Ear infection

MedDRA releases: 2024-11 · check-in free text available
2022-02-05
Survey response — 3 months, dose 3
MedDRA: Chills, Cough, Headache, Pain — Feeling: Fair · 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: Body aches headache chills coughing

MedDRA releases: 2024-11 · check-in free text available
2022-02-05
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-31
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-05-07
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-06
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-04	Moderna
2	2021-04-01	Moderna
3	2021-11-06	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-05

Systemic reaction (other): Im started menstruation cycle today.

2021-03-06

Systemic reaction (other): Im on my menstrual period now.

2021-03-07

Systemic reaction (other): Im on my menstrual period

2021-03-08

Systemic reaction (other): Im on my menstrual period.

2021-03-10

Systemic reaction (other): Im on my menstrual period.

Release 5 — day 7, dose 1

2021-03-11

Systemic reaction (other): Im on my menstrual period.

Release 6 — day 0, dose 2

2021-04-01

Systemic reaction (other): Im on my menstrual cycle.

Release 6 — days 1–6 daily, dose 2

2021-04-02

Systemic reaction (other): Im on my menstrual cycle

2021-04-03

Systemic reaction (other): I am on my menstrual cycle.

2021-04-04

Systemic reaction (other): I am on my menstrual period.

Release 7 — day 7, dose 2

2021-04-08

Systemic reaction (other): Soar throat

Release 7 — day 14, dose 2

2021-04-15

Symptoms: A persistent cough and soar throat and ear pain as well as headaches.

Release 7 — day 21, dose 2

2021-04-22

Symptoms: Numbness in left leg and feet.

Release 8 — day 28, dose 2

2021-04-29

Symptoms: Headache and menstrual period.

Release 10 — day 42, dose 3

2021-12-18

Symptoms: Ear infection

Release 11 — 3 months, dose 3

2022-02-05

Symptoms: Body aches headache chills coughing

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	Chills	·	·	✓
SD	Cough	✓	✓	✓
SD	Ear infection	·	·	✓
SD	Ear pain	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain	·	·	✓
SRO	Menstruation normal	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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