Y6V-67121-72634

4 vaccinations 6 coded responses 28 check-ins 6 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 322 / FL
Registered: 2021-01-05

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Possible VAERS report

VAERS ID	Confidence	Score	Runner-up	Shared symptoms	Dose	State	VAERS vaccinated / onset / received	Call case
2281399 (opens in a new window)	low	8 / 11	7	0 of 17 VAERS symptoms	same dose (4)	CA differs	2022-04-15 / 2022-04-27 / 2022-05-17 received 153 days before the last call	case 1094499

From the VAERS matching of call center cases (loader/vaers_match_*). Only the best match is shown, and only if it scores 8 or more out of 11. The score adds up timing (VAERS received soon after the call center contact), dose and shared symptoms; state only breaks ties. Confidence is high when the score is 8+ and at least 3 points ahead of the runner-up, medium when 5+ and 2 ahead, otherwise low. A match is a likely link, not a confirmed one.

Timeline

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

2021-01-04
Dose 1 — Moderna
2021-01-05
Registered in v-safe
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-01
Dose 2 — Moderna
2021-02-01
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-08
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-03
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-29
Dose 3 — Moderna
Co-administered: Flu
2021-08-02
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-01
Survey response — 12 months, dose 2
MedDRA: Cerebrovascular accident — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Had a stroke

MedDRA releases: 2024-11 · check-in free text available
2022-02-01
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-02-08
Call 1 — Requested Callback
2022-02-08
Call successful
Does not wish to fill out VAERS report
2022-04-15
Dose 4 — Moderna
2022-04-29
Survey response — day 14, dose 4
MedDRA: Atrial fibrillation, Brain operation, COVID-19, Cerebrovascular accident, Computerised tomogram head abnormal, Intracranial aneurysm, Magnetic resonance imaging head abnormal, Vertigo — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: January 13th I contacted Covid which caused my heart to go into Afib I had extreme vertigo and a stroke. MRI an Cat scan revealed an aneurysm. Upon brain surgery they couldn't find it.

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Report sent to call center — day 14, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-08
Survey response — day 21, dose 4
MedDRA: Neck pain, Pain, Pain in extremity — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Pain in neck radiating down left arm relieved upon taking nitroglycerin.

MedDRA releases: 2024-11 · check-in free text available
2022-05-08
Report sent to call center — day 21, dose 4
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-05-09
Call 1 — Left Voicemail
2022-05-13
Survey response — day 28, dose 4
MedDRA: Chest pain, Hospitalisation — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Chest pains admitted to (b)(6) Center 5/8/22 to 5/11/22

MedDRA releases: 2024-11 · check-in free text available
2022-05-13
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-05-17
Call successful
Completed over the phone
2022-05-17
Call successful
Completed over the phone
2022-05-17
Call successful
Completed over the phone
2022-05-30
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-15
Survey response — 3 months, dose 4
MedDRA: Vertigo — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Vertigo

MedDRA releases: 2024-11 · check-in free text available
2022-07-15
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-07-19
Call 1 — Left Voicemail
2022-10-14
Survey response — 6 months, dose 4
MedDRA: Acute kidney injury, Blood potassium decreased, COVID-19, Dehydration, Dialysis, Office visit, Pneumonia, Sepsis — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: July 28th diagnosed with pneumonia, sepsis, low potassium ,dehydration and acute kidney injury which caused me to go on dialysis. My kidney doctor says that happen because Covid was still in my body snd caused the injury to my kidneys.

MedDRA releases: 2024-11 · check-in free text available
2022-10-14
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-10-17
Call successful
Reported to VAERS during previous contact from GDIT
2022-10-17
Call successful
Reported to VAERS during previous contact from GDIT
2023-04-18
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-02-01	Moderna
3	2021-07-29	Moderna	Flu
4	2022-04-15	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-02-01	Successful 2022-02-08	Does not wish to fill out VAERS report
2022-04-29	Successful 2022-05-17	Completed over the phone
2022-05-08	Successful 2022-05-17	Completed over the phone
2022-05-13	Successful 2022-05-17	Completed over the phone
2022-07-15	Successful 2022-10-17	Reported to VAERS during previous contact from GDIT
2022-10-14	Successful 2022-10-17	Reported to VAERS during previous contact from GDIT

Free text

Release 11 — 12 months, dose 2

2022-02-01

Symptoms: Had a stroke

Release 11 — day 14, dose 4

2022-04-29

Symptoms: January 13th I contacted Covid which caused my heart to go into Afib I had extreme vertigo and a stroke. MRI an Cat scan revealed an aneurysm. Upon brain surgery they couldn't find it.

Release 11 — day 21, dose 4

2022-05-08

Symptoms: Pain in neck radiating down left arm relieved upon taking nitroglycerin.

Release 11 — day 28, dose 4

2022-05-13

Symptoms: Chest pains admitted to (b)(6) Center 5/8/22 to 5/11/22

redacted (b)(6)

Release 12 — 3 months, dose 4

2022-07-15

Symptoms: Vertigo

Release 12 — 6 months, dose 4

2022-10-14

Symptoms: July 28th diagnosed with pneumonia, sepsis, low potassium ,dehydration and acute kidney injury which caused me to go on dialysis. My kidney doctor says that happen because Covid was still in my body snd caused the injury to my kidneys.

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	Acute kidney injury	·	·	✓
SD	Atrial fibrillation	·	·	✓
SD	Blood potassium decreased	·	·	✓
SD	Brain operation	·	·	✓
SD	Cerebrovascular accident	·	·	✓
SD	Chest pain	·	·	✓
SD	Computerised tomogram head abnormal	·	·	✓
SD	COVID-19	·	·	✓
SD	Dehydration	·	·	✓
SD	Dialysis	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Intracranial aneurysm	·	·	✓
SD	Magnetic resonance imaging head abnormal	·	·	✓
SD	Neck pain	·	·	✓
SD	Office visit	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pneumonia	·	·	✓
SD	Sepsis	·	·	✓
SD	Vertigo	·	·	✓

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