EMR-21055-58917
3 vaccinations
2 coded responses
2 check-ins
2 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 46-50
- ZIP prefix
- 182 / PA
- Registered
- 2021-08-16
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-06
Dose 1 — Moderna
-
2021-02-04
Dose 2 — Moderna
-
2021-08-16
Registered in v-safe
-
2021-10-22
Dose 3 — Moderna
-
2022-02-04
Survey response — 12 months, dose 2MedDRA: Blood potassium decreased, Muscle spasms, Vertigo, Vertigo positional — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: Bpv vertigo , low potassium , right neck muscle spasmMedDRA releases: 2024-11 · check-in free text available
-
2022-02-04
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-02-09
-
2022-02-10
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-04-23
Survey response — 6 months, dose 3MedDRA: Fibroadenoma of breast, Renal cyst, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Cortisol kidney cyst , fibroadenoma on breast . Never had cysts or adenomas prior to Moderna vaccines · Healthcare visit (other): BiopsyMedDRA releases: 2024-11 · check-in free text available
-
2022-04-23
Report sent to call center — 6 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-04-25
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-06 | Moderna | No |
| 2 | 2021-02-04 | Moderna | No |
| 3 | 2021-10-22 | Moderna | No |
Call center
2 call center cases
2 successful
Free text
Release 11 — 12 months, dose 2
Symptoms: Bpv vertigo , low potassium , right neck muscle spasm
Release 11 — 6 months, dose 3
Symptoms: Cortisol kidney cyst , fibroadenoma on breast . Never had cysts or adenomas prior to Moderna vaccines
Healthcare visit (other): Biopsy
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 | Unevaluable event | · | · | ✓ |
| SD | Blood potassium decreased | · | · | ✓ |
| SD | Fibroadenoma of breast | · | · | ✓ |
| SD | Muscle spasms | · | · | ✓ |
| SD | Renal cyst | · | · | ✓ |
| SD | Vertigo | · | · | ✓ |
| SD | Vertigo positional | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release