6HA-13163-00633

3 vaccinations 14 coded responses 32 check-ins 14 free-text entries 6 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 773 / TX
Registered: 2021-01-10

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

2021-01-10
Registered in v-safe
2021-01-10
Dose 1 — Moderna
2021-01-10
Survey response — day 0, dose 1
MedDRA: Somnolence — Feeling: Fair · Site: Pain · Headache

Free text: Sleepy

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

Free text: Sleepiness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-12
Survey response — days 1–6 daily, dose 1
MedDRA: Somnolence — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Free text: Sleepy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Respiratory tract congestion — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-17
Survey response — day 7, dose 1
MedDRA: Epistaxis, Respiratory tract congestion — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Chest Congestion and bloody nose for the last 4 days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Report sent to call center — day 7, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-01
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-05
Dose 2 — Moderna
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Oropharyngeal pain — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Fatigue or tiredness, Nausea

Free text: Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — days 1–6 daily, dose 2
MedDRA: Pain — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Pain all over

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-12
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-19
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-02-26
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-05
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-12
Survey response — day 35, dose 2
MedDRA: Jaw disorder, Joint dislocation — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Jaw ( tore or cracked )

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Survey response — day 42, dose 2
MedDRA: Pain in jaw — Feeling: Fair

Free text: My jaw is very sore on the left side under my ear.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-07-30
Call 1 — Left Voicemail
2021-08-06
Survey response — 6 months, dose 2
MedDRA: Office visit, Pain in jaw — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: TMJ · Healthcare visit (other): Dr. Visit in house

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-06
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-15
Dose 3 — Pfizer-BioNTech
2021-10-25
Health check-in — day 7, dose 3
Feeling: Fair · None

Adult check-in
2021-10-29
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-05
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-12
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-11-19
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-11-19
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-26
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-14
Survey response — 3 months, dose 3
MedDRA: Condition aggravated, Cough, Fatigue, Medical counselling, Pre-existing disease, Respiratory tract congestion — Feeling: Fair · 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: Symptoms: Cough congestion fatigue copd exacerbations · Healthcare visit (other): Filed up with Dr.

MedDRA releases: 2024-11 · check-in free text available
2022-01-14
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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-01-18
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-15
Survey response — 6 months, dose 3
MedDRA: Influenza, Pre-existing disease, Respiratory tract congestion, Sinusitis — Feeling: Poor · Be unable to work or attend school

Free text: I have severe sinus infection and have chest congestion. I had the flu 3 weeks ago and please honest infection is due to allergies.

MedDRA releases: 2024-11 · check-in free text available
2022-10-15
Survey response — 12 months, dose 3
MedDRA: Salivary gland neoplasm, Surgery, Tumour excision — Feeling: Poor · 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: Symptoms: Tumor of the parotid salivary gland, requiring surgical removal of tumor. · Healthcare visit (other): Surgery

MedDRA releases: 2024-11 · check-in free text available
2022-10-15
Report sent to call center — 12 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-17
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-10	Moderna
2	2021-02-05	Moderna
3	2021-10-15	Pfizer-BioNTech	No

Call center

6 call center cases

4 successful · 2 priority 2/3 (triaged and no follow up)

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 1 — day 0, dose 1

2021-01-10

Systemic reaction (other): Sleepy

Release 1 — days 1–6 daily, dose 1

2021-01-11

Systemic reaction (other): Sleepiness

2021-01-12

Systemic reaction (other): Sleepy

Release 2 — days 1–6 daily, dose 1

2021-01-16

Systemic reaction (other): Congestion

Release 2 — day 7, dose 1

2021-01-17

Systemic reaction (other): Chest Congestion and bloody nose for the last 4 days.

Release 3 — days 1–6 daily, dose 2

2021-02-07

Systemic reaction (other): Sore throat

2021-02-08

Systemic reaction (other): Sore throat

2021-02-09

Systemic reaction (other): Pain all over

Release 5 — day 35, dose 2

2021-03-12

Symptoms: Jaw ( tore or cracked )

Release 5 — day 42, dose 2

2021-03-19

Symptoms: My jaw is very sore on the left side under my ear.

Release 9 — 6 months, dose 2

2021-08-06

Symptoms: TMJ

Healthcare visit (other): Dr. Visit in house

Release 10 — 3 months, dose 3

2022-01-14

Symptoms: Cough congestion fatigue copd exacerbations

Healthcare visit (other): Filed up with Dr.

Release 11 — 6 months, dose 3

2022-04-15

Symptoms: I have severe sinus infection and have chest congestion. I had the flu 3 weeks ago and please honest infection is due to allergies.

Release 12 — 12 months, dose 3

2022-10-15

Symptoms: Tumor of the parotid salivary gland, requiring surgical removal of tumor.

Healthcare visit (other): 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	Medical counselling	·	·	✓
HCVO	Office visit	✓	·	✓
HCVO	Surgery	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Cough	·	·	✓
SD	Fatigue	·	·	✓
SD	Influenza	·	·	✓
SD	Jaw disorder	✓	·	✓
SD	Joint dislocation	○	✓	○
SD	Pain in jaw	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Salivary gland neoplasm	·	·	✓
SD	Sinusitis	·	·	✓
SD	Tumour excision	·	·	✓
SRO	Epistaxis	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Somnolence	✓	✓	✓

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