ZQK-14065-34416
3 vaccinations
4 coded responses
32 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 783 / TX
- Registered
- 2021-03-03
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-03-02
Dose 1 — Moderna
-
2021-03-03
Registered in v-safe
- 2021-03-03
- 2021-03-04
- 2021-03-05
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-16
- 2021-03-23
-
2021-03-30
Dose 2 — Moderna
- 2021-03-30
- 2021-03-31
- 2021-04-01
-
2021-04-03
Survey response — days 1–6 daily, dose 2MedDRA: Pre-existing disease — Feeling: Fair · Chills, HeadacheFree text: I suffer from allergies and this symptoms are usually on my life.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-05
- 2021-04-06
- 2021-04-13
-
2021-04-20
Survey response — day 21, dose 2MedDRA: Pain of skin — Feeling: GoodFree text: When I tried to brush my hair and lift up my left arm, it feels heavy and hurts. Other than that I feel great.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-27
Survey response — day 28, dose 2MedDRA: Limb discomfort — Feeling: GoodFree text: Still cannot pick up my arm pass my shoulder, feels very heavy and pain.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-05
- 2021-05-11
- 2021-06-29
- 2021-09-28
-
2021-11-01
Dose 3 — Moderna
- 2021-11-02
- 2021-11-03
- 2021-11-05
- 2021-11-06
- 2021-11-07
- 2021-11-08
- 2021-11-15
- 2021-11-24
- 2021-11-29
-
2021-12-06
Survey response — day 35, dose 3MedDRA: Myocardial infarction, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: June and July has two experiences with mild heart attack, in August they put me in pre diabetes meds,cholesterol needs and heart meds. Now I'm thinking of all this is related. · Healthcare visit (other): SpecialistMedDRA releases: 2024-11 · check-in free text available
-
2021-12-06
Report sent to call center — day 35, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2021-12-09
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-02 | Moderna | |
| 2 | 2021-03-30 | Moderna | |
| 3 | 2021-11-01 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-12-06 | Successful 2021-12-09 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): I suffer from allergies and this symptoms are usually on my life.
Release 7 — day 21, dose 2
Symptoms: When I tried to brush my hair and lift up my left arm, it feels heavy and hurts. Other than that I feel great.
Release 8 — day 28, dose 2
Symptoms: Still cannot pick up my arm pass my shoulder, feels very heavy and pain.
Release 10 — day 35, dose 3
Symptoms: June and July has two experiences with mild heart attack, in August they put me in pre diabetes meds,cholesterol needs and heart meds. Now I'm thinking of all this is related.
Healthcare visit (other): Specialist
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 | Office visit | · | · | ✓ |
| SD | Limb discomfort | ✓ | ✓ | ✓ |
| SD | Myocardial infarction | · | · | ✓ |
| SD | Pain of skin | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release