23N-11345-17138

4 vaccinations 15 coded responses 54 check-ins 15 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 857 / AZ
Registered: 2021-03-03

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

2021-03-03
Registered in v-safe
2021-03-03
Dose 1 — Moderna
2021-03-03
Survey response — day 0, dose 1
MedDRA: Dizziness, Erythema, Headache, Hypoaesthesia, Paraesthesia — Feeling: Poor · Joint pains · Be unable to do your normal daily activities

Free text: While was advised to wait 30 minutes because of a history of allergic reactions in the past. While waiting my hands turned red tgen my leg and feet were numb and tingling and I was light headed and dizzy. I was assessed by the paramedics vitals stable blood sugar was 103 stayed there clise to an hour able to drive home but I am still feeling a little lite headed have a history of peripheral neuropathy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — days 1–6 daily, dose 1
MedDRA: Bradykinesia, Dizziness, Head discomfort, Pruritus — Feeling: Fair · Be unable to do your normal daily activities

Free text: Itching to back, abdomen, neck, right arm used Cortisone cream it subside, still a little dizzy, moving slow being careful, and pressure in my head

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Feeling abnormal, Head discomfort — Feeling: Fair

Free text: Pressure in my head and a little foggy but less dizzy

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: Feeling abnormal, Head discomfort — Feeling: Fair

Free text: Pressure in my head and s little foggy but a bit better

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: Dizziness, Feeling abnormal — Feeling: Fair

Free text: Foggy and light headed, resting not overdoing

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: Dizziness, Feeling abnormal — Feeling: Fair

Free text: Still a bit foggy but a little better today only slightly lightheaded

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling abnormal — Feeling: Fair

Free text: A bit foggy otherwise recovering slowly doing little bit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — day 7, dose 1
MedDRA: Feeling abnormal — Feeling: Fair

Free text: A little better today not as foggy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-31
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-05
Dose 2 — Moderna
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue, Headache, Hypoaesthesia, Injection site pain, Myalgia, Pre-existing disease, Somnolence — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: On 4/5/21 headache, numbess to legs and feet, nausea, muscle aches groggy 4/6/21 tired, numbness to legs and feet(groggy, very sore left shoulder the injection site 4/7/21 tired, groggy, numbness to less and feet more that usual I have peripheral neuropathy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-09
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling abnormal, Sensory level abnormal — Feeling: Fair · Fatigue or tiredness

Free text: Head feels boggy sensory is off

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

Adult check-in
2021-04-11
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling abnormal — Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Free text: Both 4/10 and 4/11 head feels Boggy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Survey response — day 7, dose 2
MedDRA: Feeling abnormal — Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Free text: Head feels Boggy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-26
Health check-in — day 21, dose 2
Feeling: Fair

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

Adult check-in
2021-05-10
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-05-17
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-05
Survey response — 3 months, dose 2
MedDRA: Fall, Joint dislocation, Joint range of motion decreased, Knee operation, Lower limb fracture, Mobility decreased, Office visit, Splint application — 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, Emergency room or emergency department visit, Hospitalization

Free text: Had a horrible fall fractured and dislodged my right knee cap (patella) had surgery still have a stabilizer splint can't bend my knee yet can weight bear and walk a little bit. Under Dr.s care.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-05
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-08
Call 1 — Left Voicemail
2021-07-09
Call 2 — Left Voicemail
2021-07-09
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-04
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-11-01
Dose 3 — Moderna
2021-11-01
Health check-in — day 0, dose 3
Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-08
Health check-in — day 7, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-15
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-22
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-29
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-06
Survey response — day 35, dose 3
MedDRA: Fall, Knee operation, Lumbar vertebral fracture, Magnetic resonance imaging abnormal, Pain, Patella fracture, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Had MRI of my lumbar area have a fracture at L - 5 have severe pain probably related to my fall in May when I fractured my Patella and had surgery. · Healthcare visit (other): Will follow up with Ortho Dr. For my back and also see my PCP

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Report sent to call center — day 35, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-08
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-13
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-31
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-05-03
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-09-15
Dose 4 — Moderna
2022-09-15
Survey response — day 0, dose 4
MedDRA: Erythema, Immediate post-injection reaction — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Hands turned red within 10 minutes after receiving shot

MedDRA releases: 2024-11 · check-in free text available
2022-09-16
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-09-17
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-09-18
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-09-19
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-09-20
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-09-21
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-09-22
Health check-in — day 7, dose 4
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-09-29
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-10-07
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-10-13
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-10-20
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-10-27
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-12-15
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2023-03-16
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-03	Moderna
2	2021-04-05	Moderna
3	2021-11-01	Moderna	No
4	2022-09-15	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 4 — day 0, dose 1

2021-03-03

Systemic reaction (other): While was advised to wait 30 minutes because of a history of allergic reactions in the past. While waiting my hands turned red tgen my leg and feet were numb and tingling and I was light headed and dizzy. I was assessed by the paramedics vitals stable blood sugar was 103 stayed there clise to an hour able to drive home but I am still feeling a little lite headed have a history of peripheral neuropathy

Release 5 — days 1–6 daily, dose 1

2021-03-04

Systemic reaction (other): Itching to back, abdomen, neck, right arm used Cortisone cream it subside, still a little dizzy, moving slow being careful, and pressure in my head

2021-03-05

Systemic reaction (other): Pressure in my head and a little foggy but less dizzy

2021-03-06

Systemic reaction (other): Pressure in my head and s little foggy but a bit better

2021-03-07

Systemic reaction (other): Foggy and light headed, resting not overdoing

2021-03-08

Systemic reaction (other): Still a bit foggy but a little better today only slightly lightheaded

2021-03-09

Systemic reaction (other): A bit foggy otherwise recovering slowly doing little bit

Release 5 — day 7, dose 1

2021-03-10

Systemic reaction (other): A little better today not as foggy

Release 7 — days 1–6 daily, dose 2

2021-04-07

Systemic reaction (other): On 4/5/21 headache, numbess to legs and feet, nausea, muscle aches groggy 4/6/21 tired, numbness to legs and feet(groggy, very sore left shoulder the injection site 4/7/21 tired, groggy, numbness to less and feet more that usual I have peripheral neuropathy

2021-04-09

Systemic reaction (other): Head feels boggy sensory is off

2021-04-11

Systemic reaction (other): Both 4/10 and 4/11 head feels Boggy

Release 7 — day 7, dose 2

2021-04-12

Systemic reaction (other): Head feels Boggy

Release 9 — 3 months, dose 2

2021-07-05

Symptoms: Had a horrible fall fractured and dislodged my right knee cap (patella) had surgery still have a stabilizer splint can't bend my knee yet can weight bear and walk a little bit. Under Dr.s care.

Release 10 — day 35, dose 3

2021-12-06

Symptoms: Had MRI of my lumbar area have a fracture at L - 5 have severe pain probably related to my fall in May when I fractured my Patella and had surgery.

Healthcare visit (other): Will follow up with Ortho Dr. For my back and also see my PCP

Release 12 — day 0, dose 4

2022-09-15

Systemic reaction (other): Hands turned red within 10 minutes after receiving shot

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	Fall	✓	✓	✓
SD	Fracture	○	○	○
SD	Gait disturbance	○	○	○
SD	Joint dislocation	✓	✓	✓
SD	Joint range of motion decreased	✓	✓	✓
SD	Knee operation	✓	✓	✓
SD	Lower limb fracture	✓	✓	✓
SD	Lumbar vertebral fracture	·	·	✓
SD	Magnetic resonance imaging abnormal	·	·	✓
SD	Mobility decreased	✓	✓	✓
SD	Office visit	✓	✓	✓
SD	Pain	·	·	✓
SD	Patella fracture	·	·	✓
SD	Splint application	✓	✓	✓
SD	Surgery	○	○	○
SD	Weight bearing difficulty	○	○	○
SRO	Bradykinesia	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Head discomfort	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Immediate post-injection reaction	·	·	✓
SRO	Injection site pain	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Sensory level abnormal	✓	✓	✓
SRO	Somnolence	✓	✓	✓

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