5AB-11174-81483

2 vaccinations 8 coded responses 22 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 822 / WY
Registered: 2021-01-28

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-28
Registered in v-safe
2021-01-28
Dose 1 — Moderna
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-04
Health check-in — day 7, dose 1
Feeling: Good · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-12
Survey response — day 14, dose 1
MedDRA: Headache — Feeling: Good

Free text: Headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — day 21, dose 1
MedDRA: Bone pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Excruciating bone pain (lower back and pelvis)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Dose 2 — Moderna
2021-02-25
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-04
Survey response — day 7, dose 2
MedDRA: Gait disturbance — Feeling: Good

Free text: wobbly when standing/walking

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — day 14, dose 2
MedDRA: Balance disorder, Dizziness — Feeling: Good

Free text: Have to be extremely careful with balance issues (dizzy, wobbly, bending over and then back up is really tricky)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-11
Survey response — day 42, dose 2
MedDRA: Chest pain, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: 3 am woke up with pain in middle of chest. Pain went away in about 5 min. Have been to the doctor. · Healthcare visit (other): previously scheduled appointment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-29
Survey response — 3 months, dose 2
MedDRA: Bone pain, Dry eye, Pre-existing disease, Vision blurred — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Dry eyes and blurred vision, joint,spine (never experienced before,but believe related to old osteoporosis), pelvic bone pain(never before)do not believe any of this is related to vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-28
Survey response — 6 months, dose 2
MedDRA: Cognitive disorder — Feeling: Fair

Free text: Cognitive issues that come and go. Had them before the vaccine

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-02-18
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-02-25
Survey response — 12 months, dose 2
MedDRA: Eczema, Hand dermatitis — Feeling: Good

Free text: Exzema on hands and face.

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-28	Moderna
2	2021-02-25	Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 4 — day 14, dose 1

2021-02-12

Symptoms: Headache

Release 4 — day 21, dose 1

2021-02-19

Symptoms: Excruciating bone pain (lower back and pelvis)

Release 5 — day 7, dose 2

2021-03-04

Systemic reaction (other): wobbly when standing/walking

Release 5 — day 14, dose 2

2021-03-11

Symptoms: Have to be extremely careful with balance issues (dizzy, wobbly, bending over and then back up is really tricky)

Release 7 — day 42, dose 2

2021-04-11

Symptoms: 3 am woke up with pain in middle of chest. Pain went away in about 5 min. Have been to the doctor.

Healthcare visit (other): previously scheduled appointment

Release 8 — 3 months, dose 2

2021-05-29

Symptoms: Dry eyes and blurred vision, joint,spine (never experienced before,but believe related to old osteoporosis), pelvic bone pain(never before)do not believe any of this is related to vaccine.

Release 9 — 6 months, dose 2

2021-08-28

Symptoms: Cognitive issues that come and go. Had them before the vaccine

Release 11 — 12 months, dose 2

2022-02-25

Symptoms: Exzema on hands and face.

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	Unevaluable event	✓	✓	✓
SD	Balance disorder	✓	✓	✓
SD	Bone pain	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Cognitive disorder	✓	·	✓
SD	Dizziness	✓	✓	✓
SD	Dry eye	✓	✓	✓
SD	Eczema	·	·	✓
SD	Hand dermatitis	·	·	✓
SD	Headache	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Vision blurred	✓	✓	✓
SRO	Gait disturbance	✓	✓	✓

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