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
-
2021-03-25
Dose 1 — Moderna
-
2021-04-22
Dose 2 — Moderna
-
2021-04-23
Registered in v-safe
-
2021-04-23
Health check-in — days 1–6 daily, dose 2Feeling: 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 activitiesAdult check-in
-
2021-04-24
Survey response — days 1–6 daily, dose 2MedDRA: Adverse reaction — Feeling: Fair · Site: Pain · Headache, Fatigue or tirednessFree text: Want to report symptoms after first shotMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-26
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, NauseaAdult check-in
-
2021-04-28
Survey response — days 1–6 daily, dose 2MedDRA: 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 activitiesFree 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
-
2021-04-29
Health check-in — day 7, dose 2Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
- 2021-05-13
-
2021-05-28
Survey response — day 35, dose 2MedDRA: Balance disorder, Brain fog, Fatigue, Headache, Impaired work ability, Tinnitus — Feeling: Poor · Be unable to work, Be unable to do your normal daily activitiesFree 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
-
2021-12-24
Dose 3 — Moderna
-
2022-06-24
Survey response — 6 months, dose 3MedDRA: 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, HospitalizationFree text: Symptoms: Progressive weakness, pain, neuropathy, dizziness, memory loss, ataxia. Actually fell and broke shoulder. · Healthcare visit (other): Exams by SpecialistsMedDRA releases: 2024-11 · check-in free text available
-
2022-06-24
Report sent to call center — 6 months, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2022-06-27
-
2022-07-06
Call successfulCompleted over the phone
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-25 | Moderna | |
| 2 | 2021-04-22 | Moderna | |
| 3 | 2021-12-24 | Moderna | No |
Call center
1 call center case
1 successful
VAERS report filed, before or during a call: 1
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Want to report symptoms after first shot
Release 8 — days 1–6 daily, dose 2
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
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
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
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| HCVO | Office visit | · | · | ✓ |
| SD | Amnesia | · | · | ✓ |
| SD | Asthenia | · | · | ✓ |
| SD | Ataxia | · | · | ✓ |
| SD | Balance disorder | ✓ | ✓ | ✓ |
| SD | Brain fog | ✓ | ✓ | ✓ |
| SD | Dizziness | · | · | ✓ |
| SD | Fall | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Impaired work ability | ✓ | ✓ | ✓ |
| SD | Neuropathy peripheral | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Shoulder fracture | · | · | ✓ |
| SD | Tinnitus | ✓ | ✓ | ✓ |
| SRO | Adverse reaction | ✓ | ✓ | ✓ |
| SRO | Condition aggravated | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release