43Y-88551-18938

5 vaccinations 20 coded responses 22 check-ins 19 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 857 / AZ
Registered: 2021-04-11

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Timeline

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

2021-03-12
Dose 1 — Moderna
2021-04-08
Dose 2 — Moderna
2021-04-11
Registered in v-safe
2021-04-11
Survey response — days 1–6 daily, dose 2
MedDRA: Muscular weakness, Taste disorder, Visual impairment — Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Olfactory, taste changes; eye-vision problems. Previous complex partial seizure diagnosis years ago returned with weakened and weakened extremities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Survey response — days 1–6 daily, dose 2
MedDRA: Head discomfort, Headache, Tinnitus, Tremor — Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Pressure feeling, pain in head, ears buzzing.. slight extremity tremors

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — days 1–6 daily, dose 2
MedDRA: Head discomfort, Hypoaesthesia, Thermal burns of eye, Tinnitus — Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Head pressure n pain, buzzing in ears, eyes burningn pain, feeling of numbing extremities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — days 1–6 daily, dose 2
MedDRA: Ageusia, Anosmia, Tinnitus — Feeling: Fair · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Smell and taste affected, neck and head-ears buzzing sound, eyes, throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — day 7, dose 2
MedDRA: Burning sensation, Hypoaesthesia, Limb discomfort, Throat irritation, Tongue discomfort — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Feeling of numbness, heaviness in extremities; feeling of scalded, burning tongue and throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-29
Survey response — day 21, dose 2
MedDRA: Asthenia, Bradyphrenia, Chills, Fatigue, Feeling jittery, Feeling of despair, Headache, Nausea, Office visit, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Extreme fatigue n weakness, slow thinking and jittery, headache n despondent, sudden chills, no fevers, nausea. Not constant, daily, but sporadic throughout the day lasting for 3-4 hours. · Healthcare visit (other): In Drs office

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-06
Survey response — day 28, dose 2
MedDRA: Asthenia, Headache, Muscular weakness, Musculoskeletal discomfort, Office visit, Oral discomfort, SARS-CoV-2 test negative, Toothache — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Bad intermittent headaches, pressure on neck, jaws, shoulders, teeth pain, weak feet and hands, sudden sporadic overall body weakness · Healthcare visit (other): Doctors visit; had a COVID test done n was negative

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-15
Survey response — day 35, dose 2
MedDRA: Cough, Pain, Sinusitis, Urinary tract infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: Congestive sinus infection, chest, head, ears, throat, cough relieved with prescribed antibiotic but reacted to antibiotic. First infection in last 12 years without flues, urinary tract infections, sinus, stomach.Body aches and pains continue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Survey response — day 42, dose 2
MedDRA: Fatigue, Headache, Pain, Pre-existing disease, Sinusitis, Tinnitus — Feeling: Poor · Be unable to do your normal daily activities

Free text: Stabbing head pains on the side of the head above the top of the ears, specially on right side, a buzzing constant sound in the ears. body pains and fatigue have been my normal fibromyalgia. Had increased with an antibiotic for sinus infection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-08
Survey response — 3 months, dose 2
MedDRA: Agitation, Anxiety, Asthenia, Chest discomfort, Discomfort, Dyspnoea, Ear discomfort, Ear pain, Eye pain, Head discomfort, Headache, Inflammation, Musculoskeletal stiffness, Ocular discomfort, Pain, Pain in jaw, Stress, Throat irritation, Toothache — Feeling: Poor · Be unable to do your normal daily activities

Free text: Inflammation around body n head, sore, scratchy throat n pain/pressure in teeth, jaws, ears, eyes, temples seem to increase with stress, agitation, anxiety.. pressure Weak feeling in chest/ breathing.Body aches and is stiff

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-09
Survey response — 6 months, dose 2
MedDRA: Condition aggravated, Dyspnoea, Eye disorder, Office visit, Pre-existing disease, Sinus disorder — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: An persistent increase of my diagnosed fibromyalgia and chemical sensitivities symptoms since the second vaccine, sinus, eye and breathing difficulties problems · Healthcare visit (other): Change of PP, office visit

MedDRA releases: 2024-11 · check-in free text available
2021-10-09
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-12
Call 1 — Left Voicemail
2021-11-07
Dose 3 — Moderna
2022-04-09
Survey response — 12 months, dose 2
MedDRA: Agitation, Anxiety, Asthenia, Chest discomfort, Dizziness, Dyspnoea, Head discomfort, Hypertension, Inflammation, Poor quality sleep, Pre-existing disease, SARS-CoV-2 test negative — Feeling: Poor · Be unable to do your normal daily activities

Free text: Difficulty breathing/pressure in chest/overall weakness/dizziness head pressure/inflammationhigh blood pressure spikesagitation, anxiety..unable to get restful sleep...have .fibromyalgia, two COVID shots and one booster..tested negative for cor

MedDRA releases: 2024-11 · check-in free text available
2022-06-06
Dose 4 — Moderna
2022-11-20
Dose 5 — Moderna
Co-administered: Flu
2022-11-20
Survey response — day 0, dose 5
MedDRA: Fibromyalgia — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: I have a diagnosis of fibromyalgia

MedDRA releases: 2024-11 · check-in free text available
2022-11-22
Survey response — days 1–6 daily, dose 5
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Increased fybromyagia symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-11-23
Survey response — days 1–6 daily, dose 5
MedDRA: Blood pressure increased — Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Higher blood pressure, do have medication.

MedDRA releases: 2024-11 · check-in free text available
2022-11-25
Survey response — days 1–6 daily, dose 5
MedDRA: Agitation, Anxiety, Blood pressure increased, Fibromyalgia — Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Fybromyalgia, high blood pressure spikes, agitation/ anxiety

MedDRA releases: 2024-11 · check-in free text available
2022-11-27
Health check-in — day 7, dose 5
Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches, Diarrhea

Adult check-in
2022-12-04
Survey response — day 14, dose 5
MedDRA: Balance disorder, Chills, Cough, Dizziness, Headache, Hyperhidrosis, Influenza like illness, Pain, Tinnitus, Visual impairment — Feeling: Poor · Be unable to do your normal daily activities

Free text: Cough, headache, ear ringing, unsteady, dizzy, vision problems, Feeling of a very bad flu, body aches, chills and sweats..

MedDRA releases: 2024-11 · check-in free text available
2022-12-11
Survey response — day 21, dose 5
MedDRA: Fibromyalgia, Hypertension, Sinusitis, Tremor, Unevaluable event, Visual impairment — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Fybromyalgia, tremors, vision problems. ..high blood pressure, sinusitis · Healthcare visit (other): No health visit

MedDRA releases: 2024-11 · check-in free text available
2022-12-11
Report sent to call center — day 21, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-12-12
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-12
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-12
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-18
Survey response — day 28, dose 5
MedDRA: COVID-19, Cough, Dyspnoea, Medical counselling — Feeling: Poor · Be unable to do your normal daily activities

Free text: Had COVID and flu shot together end of November. By Dec.4 developed COVID. By Dec. 8 felt better. On Dec. 9 felt like all COVID symptoms had returned, with a worse cough and extremely weak breathing, chest feeling, call to my PP gave me Paxlovid.

MedDRA releases: 2024-11 · check-in free text available
2023-01-03
Survey response — day 42, dose 5
MedDRA: Asthenia, Brain fog, Feeling abnormal, Head discomfort, Office visit, Productive cough, Tinnitus, Visual impairment — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-01-03
Report sent to call center — day 42, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2023-01-04
Call 1 — Requested Callback
2023-01-11
Callback requested for
03:00PM ET
2023-01-11
Call successful
Completed over the phone
2023-01-11
Call successful
Completed over the phone

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-12	Moderna
2	2021-04-08	Moderna
3	2021-11-07	Moderna	No
4	2022-06-06	Moderna	No
5	2022-11-20	Moderna	Flu

Call center

5 call center cases

5 successful

VAERS report filed, before or during a call: 2

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-11

Systemic reaction (other): Olfactory, taste changes; eye-vision problems. Previous complex partial seizure diagnosis years ago returned with weakened and weakened extremities

2021-04-12

Systemic reaction (other): Pressure feeling, pain in head, ears buzzing.. slight extremity tremors

2021-04-13

Systemic reaction (other): Head pressure n pain, buzzing in ears, eyes burningn pain, feeling of numbing extremities

2021-04-14

Systemic reaction (other): Smell and taste affected, neck and head-ears buzzing sound, eyes, throat

Release 7 — day 7, dose 2

2021-04-15

Systemic reaction (other): Feeling of numbness, heaviness in extremities; feeling of scalded, burning tongue and throat

Release 8 — day 21, dose 2

2021-04-29

Symptoms: Extreme fatigue n weakness, slow thinking and jittery, headache n despondent, sudden chills, no fevers, nausea. Not constant, daily, but sporadic throughout the day lasting for 3-4 hours.

Healthcare visit (other): In Drs office

Release 8 — day 28, dose 2

2021-05-06

Symptoms: Bad intermittent headaches, pressure on neck, jaws, shoulders, teeth pain, weak feet and hands, sudden sporadic overall body weakness

Healthcare visit (other): Doctors visit; had a COVID test done n was negative

Release 8 — day 35, dose 2

2021-05-15

Symptoms: Congestive sinus infection, chest, head, ears, throat, cough relieved with prescribed antibiotic but reacted to antibiotic. First infection in last 12 years without flues, urinary tract infections, sinus, stomach.Body aches and pains continue

Release 8 — day 42, dose 2

2021-05-20

Symptoms: Stabbing head pains on the side of the head above the top of the ears, specially on right side, a buzzing constant sound in the ears. body pains and fatigue have been my normal fibromyalgia. Had increased with an antibiotic for sinus infection.

Release 9 — 3 months, dose 2

2021-07-08

Symptoms: Inflammation around body n head, sore, scratchy throat n pain/pressure in teeth, jaws, ears, eyes, temples seem to increase with stress, agitation, anxiety.. pressure Weak feeling in chest/ breathing.Body aches and is stiff

Release 10 — 6 months, dose 2

2021-10-09

Symptoms: An persistent increase of my diagnosed fibromyalgia and chemical sensitivities symptoms since the second vaccine, sinus, eye and breathing difficulties problems

Healthcare visit (other): Change of PP, office visit

Release 11 — 12 months, dose 2

2022-04-09

Symptoms: Difficulty breathing/pressure in chest/overall weakness/dizziness head pressure/inflammationhigh blood pressure spikesagitation, anxiety..unable to get restful sleep...have .fibromyalgia, two COVID shots and one booster..tested negative for cor

Release 12 — day 0, dose 5

2022-11-20

Systemic reaction (other): I have a diagnosis of fibromyalgia

Release 12 — days 1–6 daily, dose 5

2022-11-22

Systemic reaction (other): Increased fybromyagia symptoms

2022-11-23

Systemic reaction (other): Higher blood pressure, do have medication.

2022-11-25

Systemic reaction (other): Fybromyalgia, high blood pressure spikes, agitation/ anxiety

Release 12 — day 14, dose 5

2022-12-04

Symptoms: Cough, headache, ear ringing, unsteady, dizzy, vision problems, Feeling of a very bad flu, body aches, chills and sweats..

Release 12 — day 21, dose 5

2022-12-11

Symptoms: Fybromyalgia, tremors, vision problems. ..high blood pressure, sinusitis

Healthcare visit (other): No health visit

Release 12 — day 28, dose 5

2022-12-18

Symptoms: Had COVID and flu shot together end of November. By Dec.4 developed COVID. By Dec. 8 felt better. On Dec. 9 felt like all COVID symptoms had returned, with a worse cough and extremely weak breathing, chest feeling, call to my PP gave me Paxlovid. cut off by CDC

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	✓	✓	✓
HCVO	SARS-CoV-2 test negative	✓	✓	✓
HCVO	Unevaluable event	○	✓	✓
SD	Agitation	✓	✓	✓
SD	Anxiety	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Balance disorder	·	·	✓
SD	Bradyphrenia	✓	·	✓
SD	Brain fog	·	·	✓
SD	Chest discomfort	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Condition aggravated	·	·	✓
SD	Cough	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Discomfort	✓	✓	✓
SD	Dizziness	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Ear discomfort	✓	✓	✓
SD	Ear pain	✓	✓	✓
SD	Eye disorder	·	·	✓
SD	Eye pain	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	·	·	✓
SD	Feeling jittery	✓	·	✓
SD	Feeling of despair	✓	·	✓
SD	Fibromyalgia	·	·	✓
SD	Head discomfort	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hyperhidrosis	·	·	✓
SD	Hypertension	·	·	✓
SD	Inflammation	✓	✓	✓
SD	Influenza like illness	·	·	✓
SD	Medical counselling	·	·	✓
SD	Muscular weakness	✓	✓	✓
SD	Musculoskeletal discomfort	✓	✓	✓
SD	Musculoskeletal stiffness	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Ocular discomfort	✓	✓	✓
SD	Oral discomfort	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in jaw	✓	✓	✓
SD	Poor quality sleep	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Productive cough	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinus disorder	·	·	✓
SD	Sinusitis	✓	✓	✓
SD	Stress	✓	✓	✓
SD	Throat irritation	✓	✓	✓
SD	Tinnitus	✓	✓	✓
SD	Toothache	✓	✓	✓
SD	Tremor	·	·	✓
SD	Urinary tract infection	✓	✓	✓
SD	Visual impairment	·	·	✓
SRO	Ageusia	✓	✓	✓
SRO	Agitation	·	·	✓
SRO	Anosmia	✓	✓	✓
SRO	Anxiety	·	·	✓
SRO	Blood pressure increased	·	·	✓
SRO	Burning sensation	✓	✓	✓
SRO	Condition aggravated	·	·	✓
SRO	Fibromyalgia	·	·	✓
SRO	Head discomfort	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Limb discomfort	✓	✓	✓
SRO	Muscular weakness	✓	✓	✓
SRO	Pre-existing disease	·	·	✓
SRO	Taste disorder	✓	✓	✓
SRO	Thermal burns of eye	✓	✓	✓
SRO	Throat irritation	✓	✓	✓
SRO	Tinnitus	✓	✓	✓
SRO	Tongue discomfort	✓	✓	✓
SRO	Tremor	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

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