4TY-11099-93941

2 vaccinations 11 coded responses 24 check-ins 11 free-text entries 3 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 928 / CA
Registered: 2021-02-26

Relationship: Self
Race: White
Ethnicity: N/A

Timeline

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

2021-02-26
Registered in v-safe
2021-02-26
Dose 1 — Moderna
2021-02-26
Survey response — day 0, dose 1
MedDRA: Chills, Headache, Nasal discomfort — Feeling: Good · Site: Pain, Itching · Chills, Headache

Free text: I've very briefly felt chills & headache today, but these symptoms could be attributed to my Fibromyalgia, with which I frequently experience these symptoms. Also, I had an unusual burning sensation in my nose for a brief time today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Survey response — days 1–6 daily, dose 1
MedDRA: Lymphadenopathy, Oropharyngeal pain — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Either sore throat or swollen lymph nodes in neck, but for only a small portion of the day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Survey response — days 1–6 daily, dose 1
MedDRA: Condition aggravated, Fatigue, Pre-existing disease — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: I have Fibromyalgia, so the fatigue is a normal daily symptom that interferes with my ability to do work and/or other normal daily activities. However, I can differentiate it from the distinct and severe "Run-down" feeling I experienced today. This morning (day 3), I felt remarkably better than the night before. Therefore, any symptoms I feel today I am certain is only from Fibromyalgia and NOT from the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — day 7, dose 1
Feeling: Good · Headache · Be unable to do your normal daily activities

Adult check-in
2021-03-12
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-01
Dose 2 — Moderna
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Vertigo — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Vertigo, mild

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Fatigue, Fibromyalgia, Myalgia, Pre-existing disease, Rheumatoid arthritis, Vertigo — Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Mild vertigo, yet my fatigue and muscle ache/joint pain could be attributed to my diagnoses of fibromyalgia and rheumatoid arthritis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Fatigue, Pre-existing disease, Vertigo — Feeling: Fair · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Mild vertigo, fatigue and joint pains can be attributed to my diagnoses of fibromyalgia and rheumatoid arthritis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Survey response — day 7, dose 2
MedDRA: Condition aggravated, Pre-existing disease, Rheumatoid arthritis — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: The vaccine seems to have triggered my fibromyalgia and rheumatoid arthritis flares.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-24
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-30
Survey response — day 28, dose 2
MedDRA: Condition aggravated, Dyspnoea exertional, Fatigue, Muscle twitching, Myalgia, Pre-existing disease, Rheumatoid arthritis — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Debilitating fatigue to the point where i can become breathless doing very minimal activity. Increasing muscle twitching & pain. I believe vaccine triggered and worsened flares of my chronic conditions of fibromyalgia & Rheum.arthritis, aftr 2nd shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Report sent to call center — day 28, dose 2
Be unable to work · 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 35, dose 2
MedDRA: Asthenia, Fatigue — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: The fatigue/exhaustion is unrelenting. An 85 yr. old has more energy & strength than me. My level of fatigue is about that of a patient expiring in front of you. Pushing past 10-20 min of activity leads to my collapse for the rest of the day or days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Survey response — day 42, dose 2
MedDRA: Asthenia, Dyspnoea, Fatigue, Pain, Pre-existing disease — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Debilitating fatigue, pain, and weakness. Exhaustion to the point of breathlessness. 15-20+ min of activity induces collapse. More research needs to be done on how the vaccine affects people with rheumatological disease (like RA) & Fibromyalgia.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Report sent to call center — day 42, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-04-01
Survey response — 12 months, dose 2
MedDRA: Asthenia, Confusional state, Disturbance in attention, Dizziness, Hypoaesthesia, Memory impairment, Neurological symptom, Office visit, Paraesthesia, Paralysis — 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 · Emergency room or emergency department visit

Free text: Symptoms: Predominantly Neurological symptoms: numbness, tingling, severe weakness, paralysis, dizziness, confusion, memory problems & inability to concentrate · Healthcare visit (other): Specialist visit: neurology

MedDRA releases: 2024-11 · check-in free text available
2022-04-01
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · 1 call case(s)
2022-04-04
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-26	Moderna
2	2021-04-01	Moderna

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 4 — day 0, dose 1

2021-02-26

Systemic reaction (other): I've very briefly felt chills & headache today, but these symptoms could be attributed to my Fibromyalgia, with which I frequently experience these symptoms. Also, I had an unusual burning sensation in my nose for a brief time today

Release 4 — days 1–6 daily, dose 1

2021-02-27

Systemic reaction (other): Either sore throat or swollen lymph nodes in neck, but for only a small portion of the day.

2021-02-28

Systemic reaction (other): I have Fibromyalgia, so the fatigue is a normal daily symptom that interferes with my ability to do work and/or other normal daily activities. However, I can differentiate it from the distinct and severe "Run-down" feeling I experienced today. This morning (day 3), I felt remarkably better than the night before. Therefore, any symptoms I feel today I am certain is only from Fibromyalgia and NOT from the vaccine.

Release 6 — days 1–6 daily, dose 2

2021-04-05

Systemic reaction (other): Vertigo, mild

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): Mild vertigo, yet my fatigue and muscle ache/joint pain could be attributed to my diagnoses of fibromyalgia and rheumatoid arthritis

2021-04-07

Systemic reaction (other): Mild vertigo, fatigue and joint pains can be attributed to my diagnoses of fibromyalgia and rheumatoid arthritis

Release 7 — day 7, dose 2

2021-04-09

Systemic reaction (other): The vaccine seems to have triggered my fibromyalgia and rheumatoid arthritis flares.

Release 8 — day 28, dose 2

2021-04-30

Symptoms: Debilitating fatigue to the point where i can become breathless doing very minimal activity. Increasing muscle twitching & pain. I believe vaccine triggered and worsened flares of my chronic conditions of fibromyalgia & Rheum.arthritis, aftr 2nd shot cut off by CDC

Release 8 — day 35, dose 2

2021-05-06

Symptoms: The fatigue/exhaustion is unrelenting. An 85 yr. old has more energy & strength than me. My level of fatigue is about that of a patient expiring in front of you. Pushing past 10-20 min of activity leads to my collapse for the rest of the day or days. cut off by CDC

Release 8 — day 42, dose 2

2021-05-14

Symptoms: Debilitating fatigue, pain, and weakness. Exhaustion to the point of breathlessness. 15-20+ min of activity induces collapse. More research needs to be done on how the vaccine affects people with rheumatological disease (like RA) & Fibromyalgia.

Release 11 — 12 months, dose 2

2022-04-01

Symptoms: Predominantly Neurological symptoms: numbness, tingling, severe weakness, paralysis, dizziness, confusion, memory problems & inability to concentrate

Healthcare visit (other): Specialist visit: neurology

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	Asthenia	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Confusional state	·	·	✓
SD	Disturbance in attention	·	·	✓
SD	Dizziness	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Dyspnoea exertional	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Hypoaesthesia	·	·	✓
SD	Memory impairment	·	·	✓
SD	Muscle twitching	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Neurological symptom	·	·	✓
SD	Pain	✓	✓	✓
SD	Paraesthesia	·	·	✓
SD	Paralysis	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rheumatoid arthritis	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Fibromyalgia	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Nasal discomfort	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rheumatoid arthritis	✓	✓	✓
SRO	Vertigo	✓	✓	✓

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