3FM-13783-21073
4 vaccinations
5 coded responses
22 check-ins
5 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 802 / CO
- Registered
- 2021-02-17
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-30
Dose 1 — Moderna
-
2021-01-27
Dose 2 — Moderna
-
2021-02-17
Registered in v-safe
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2021-02-17
Survey response — day 21, dose 2MedDRA: Eye pain, Immediate post-injection reaction, Injection site pain, Muscular weakness, Pain — Feeling: Good · Be unable to do your normal daily activitiesFree text: Immediately after the 2nd Moderna dose, the injection site on my left arm was sore. The pain increased and by the evening my left arm was very sore with generalized generalized muscle weakness. Day 2, I slept, had bad, generalized body & eye pain.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-24
- 2021-03-03
- 2021-03-12
- 2021-04-28
- 2021-07-28
-
2021-10-19
Dose 3 — Moderna
-
2021-10-23
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-10-24
- 2021-10-25
- 2021-10-26
- 2021-11-02
-
2021-11-10
Survey response — day 21, dose 3MedDRA: Fall, Wrist fracture — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: I fell and broke both wrists and need surgery.MedDRA releases: 2024-11 · check-in free text available
-
2021-11-10
Report sent to call center — day 21, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
-
2021-11-15
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-11-16
Survey response — day 28, dose 3MedDRA: Hand fracture — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: I broke both my hands and am scheduled for surgery.MedDRA releases: 2024-11 · check-in free text available
-
2021-11-16
Report sent to call center — day 28, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2021-11-17
Call successfulDoes not wish to fill out VAERS report
- 2021-11-23
-
2021-11-30
Survey response — day 42, dose 3MedDRA: Hand fracture, Surgery — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: Symptoms: Broke both hands. Had 4 plus hour surgery. · Healthcare visit (other): SurgeryMedDRA releases: 2024-11 · check-in free text available
-
2021-11-30
Report sent to call center — day 42, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
- 2021-12-01
-
2022-01-19
Survey response — 3 months, dose 3MedDRA: Fall, Hand fracture — Feeling: FairFree text: I broke both of my hands in a fall.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-12
Dose 4 — Moderna
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2022-04-16
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2022-04-17
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Muscle or body achesAdult check-in
- 2022-04-18
- 2022-04-19
- 2022-04-26
- 2022-05-03
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-30 | Moderna | |
| 2 | 2021-01-27 | Moderna | |
| 3 | 2021-10-19 | Moderna | No |
| 4 | 2022-04-12 | Moderna | No |
Call center
3 call center cases
2 successful · 1 unsuccessful
Free text
Release 4 — day 21, dose 2
Symptoms: Immediately after the 2nd Moderna dose, the injection site on my left arm was sore. The pain increased and by the evening my left arm was very sore with generalized generalized muscle weakness. Day 2, I slept, had bad, generalized body & eye pain. cut off by CDC
Release 10 — day 21, dose 3
Symptoms: I fell and broke both wrists and need surgery.
Release 10 — day 28, dose 3
Symptoms: I broke both my hands and am scheduled for surgery.
Release 10 — day 42, dose 3
Release 10 — 3 months, dose 3
Symptoms: I broke both of my hands in a fall.
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 | Surgery | · | · | ✓ |
| SD | Eye pain | ✓ | ✓ | ✓ |
| SD | Fall | · | · | ✓ |
| SD | Hand fracture | · | · | ✓ |
| SD | Immediate post-injection reaction | ✓ | ✓ | ✓ |
| SD | Injection site pain | ✓ | ✓ | ✓ |
| SD | Muscular weakness | ✓ | ✓ | ✓ |
| SD | Pain | ✓ | ✓ | ✓ |
| SD | Surgery | · | · | ✓ |
| SD | Wrist fracture | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release