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4GE-28123-18583

3 vaccinations 4 coded responses 8 check-ins 4 free-text entries 1 call case
Sex
Female
Age at first dose
61-65
ZIP prefix
017 / MA
Registered
2021-04-23
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-03-25
    Dose 1 — Moderna
  2. 2021-04-22
    Dose 2 — Moderna
  3. 2021-04-23
    Registered in v-safe
  4. 2021-04-23
    Health check-in — days 1–6 daily, dose 2
    Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities
    Adult check-in
  5. 2021-04-24
    Survey response — days 1–6 daily, dose 2
    MedDRA: Adverse reaction — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness
    Free text: Want to report symptoms after first shot
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-04-26
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea
    Adult check-in
  7. 2021-04-28
    Survey response — days 1–6 daily, dose 2
    MedDRA: Condition aggravated, Dizziness, Pre-existing disease — Feeling: Poor · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities
    Free text: Significant exacerbation of fibromyalgia pain and wooziness .This happened after first vaccine also in addition to significant exacerbation of itching from Auto-immune skin disease (Lichen planopilaris).
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-04-29
    Health check-in — day 7, dose 2
    Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities
    Adult check-in
  9. 2021-05-13
    Health check-in — day 21, dose 2
    Feeling: Fair
    Adult check-in
  10. 2021-05-28
    Survey response — day 35, dose 2
    MedDRA: Balance disorder, Brain fog, Fatigue, Headache, Impaired work ability, Tinnitus — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities
    Free text: All these symptoms are worse: fibromyalgia pain,Brain fog, tinnitus, headaches, dysequlilibrium,Exhaustion and prurits from auto-immune skin diaease. This makes work and normal activities difficult to do.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-12-24
    Dose 3 — Moderna
  12. 2022-06-24
    Survey response — 6 months, dose 3
    MedDRA: Amnesia, Asthenia, Ataxia, Dizziness, Fall, Neuropathy peripheral, Office visit, Pain, Shoulder fracture — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization
    Free text: Symptoms: Progressive weakness, pain, neuropathy, dizziness, memory loss, ataxia. Actually fell and broke shoulder. · Healthcare visit (other): Exams by Specialists
    MedDRA releases: 2024-11 · check-in free text available
  13. 2022-06-24
    Report sent to call center — 6 months, dose 3
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
  14. 2022-06-27
  15. 2022-07-06
    Call successful
    Completed over the phone

Vaccinations

DoseDateManufacturerCo-administered
12021-03-25Moderna
22021-04-22Moderna
32021-12-24Moderna No

Call center

1 call center case

1 successful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-24

Systemic reaction (other): Want to report symptoms after first shot

Release 8 — days 1–6 daily, dose 2

2021-04-28

Systemic reaction (other): Significant exacerbation of fibromyalgia pain and wooziness .This happened after first vaccine also in addition to significant exacerbation of itching from Auto-immune skin disease (Lichen planopilaris).

Release 8 — day 35, dose 2

2021-05-28

Symptoms: All these symptoms are worse: fibromyalgia pain,Brain fog, tinnitus, headaches, dysequlilibrium,Exhaustion and prurits from auto-immune skin diaease. This makes work and normal activities difficult to do.

Release 12 — 6 months, dose 3

2022-06-24

Symptoms: Progressive weakness, pain, neuropathy, dizziness, memory loss, ataxia. Actually fell and broke shoulder.
Healthcare visit (other): Exams by Specialists

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

FieldPreferred term2021-092023-042024-11
HCVOOffice visit · · ✓
SDAmnesia · · ✓
SDAsthenia · · ✓
SDAtaxia · · ✓
SDBalance disorder ✓ ✓ ✓
SDBrain fog ✓ ✓ ✓
SDDizziness · · ✓
SDFall · · ✓
SDFatigue ✓ ✓ ✓
SDHeadache ✓ ✓ ✓
SDImpaired work ability ✓ ✓ ✓
SDNeuropathy peripheral · · ✓
SDPain · · ✓
SDShoulder fracture · · ✓
SDTinnitus ✓ ✓ ✓
SROAdverse reaction ✓ ✓ ✓
SROCondition aggravated ✓ ✓ ✓
SRODizziness ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓

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