5HP-29649-70088

2 vaccinations 13 coded responses 16 check-ins 13 free-text entries 0 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 750 / TX
Registered: 2021-01-22

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

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-01-12
Dose 1 — Moderna
2021-01-22
Registered in v-safe
2021-01-22
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-01-26
Survey response — day 14, dose 1
MedDRA: Arthralgia, Dizziness, Feeling abnormal, Injection site erythema, Injection site nodule, Injection site swelling, Memory impairment — Feeling: Fair · Be unable to do your normal daily activities

Free text: Brain fog, memory issues, aching joints, red knot & swelling in arm at shot site, dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Survey response — day 21, dose 1
MedDRA: Fatigue, Feeling abnormal, Memory impairment, Rash — Feeling: Good · Be unable to do your normal daily activities

Free text: Rash, fatigue, brain fog, memory issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Dose 2 — Moderna
2021-02-10
Survey response — day 0, dose 2
MedDRA: Disturbance in attention, Dizziness, Memory impairment — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Dizzy, difficult to concentrate, memory issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Chills, 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
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Brain fog, Dizziness, Memory impairment — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Dizziness, brain fog, memory

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Feeling abnormal, Memory impairment — Feeling: Fair · Site: Swelling, Itching · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Dizziness, memory, brain fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling abnormal — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Brain fog, memory

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — day 7, dose 2
MedDRA: Feeling abnormal, Vision blurred — Feeling: Fair · Site: Redness, Swelling, Itching · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Eyesight blurry, brain fog, memory

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Survey response — day 14, dose 2
MedDRA: Visual impairment — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Eyesight issues that I did not have before the 2nd shot. Difficulty reading or seeing computer screen.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — day 21, dose 2
MedDRA: Balance disorder, Memory impairment, Rash, Visual impairment — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Still having balance, memory, & eyesight issues, & rash.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — day 28, dose 2
MedDRA: Balance disorder, Memory impairment, Visual impairment — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Eyesight, balance, & memory issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — day 35, dose 2
MedDRA: Balance disorder, Eye disorder, Memory impairment, Rash — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Eyesight issues, memory issues, balance issues, rash, body & skin not healing from minor cuts or scrapes.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Survey response — day 42, dose 2
MedDRA: Amnesia, Asthenia, Balance disorder, Eye disorder, Impaired healing, Memory impairment, Rash, Visual impairment — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Eyesight & memory worsening. Balance issues, Rash. Skin not healing. Lack of energy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Survey response — 3 months, dose 2
MedDRA: Balance disorder, Heavy menstrual bleeding, Visual impairment — Feeling: Poor · Be unable to do your normal daily activities

Free text: Menstration is not stopping & is extremely heavy at the beginning of the period. The bleeding reduces but does not stop so I am having continuous periods. I am still having much worse eyesight & some balance issues.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-11
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-12	Moderna
2	2021-02-10	Moderna

Free text

Release 2 — day 14, dose 1

2021-01-26

Symptoms: Brain fog, memory issues, aching joints, red knot & swelling in arm at shot site, dizziness

Release 3 — day 21, dose 1

2021-02-02

Symptoms: Rash, fatigue, brain fog, memory issues

Release 4 — day 0, dose 2

2021-02-10

Systemic reaction (other): Dizzy, difficult to concentrate, memory issues

Release 4 — days 1–6 daily, dose 2

2021-02-13

Systemic reaction (other): Dizziness, brain fog, memory

2021-02-14

Systemic reaction (other): Dizziness, memory, brain fog

2021-02-15

Systemic reaction (other): Brain fog, memory

Release 4 — day 7, dose 2

2021-02-17

Systemic reaction (other): Eyesight blurry, brain fog, memory

Release 4 — day 14, dose 2

2021-02-24

Symptoms: Eyesight issues that I did not have before the 2nd shot. Difficulty reading or seeing computer screen.

Release 5 — day 21, dose 2

2021-03-05

Symptoms: Still having balance, memory, & eyesight issues, & rash.

Release 5 — day 28, dose 2

2021-03-10

Symptoms: Eyesight, balance, & memory issues

Release 5 — day 35, dose 2

2021-03-17

Symptoms: Eyesight issues, memory issues, balance issues, rash, body & skin not healing from minor cuts or scrapes.

Release 6 — day 42, dose 2

2021-03-25

Symptoms: Eyesight & memory worsening. Balance issues, Rash. Skin not healing. Lack of energy.

Release 8 — 3 months, dose 2

2021-05-12

Symptoms: Menstration is not stopping & is extremely heavy at the beginning of the period. The bleeding reduces but does not stop so I am having continuous periods. I am still having much worse eyesight & some balance issues.

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
SD	Amnesia	○	✓	○
SD	Arthralgia	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Balance disorder	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Eye disorder	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Heavy menstrual bleeding	✓	✓	✓
SD	Impaired healing	✓	✓	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site nodule	✓	✓	✓
SD	Injection site swelling	✓	✓	✓
SD	Memory impairment	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Visual impairment	✓	✓	✓
SRO	Brain fog	✓	✓	✓
SRO	Disturbance in attention	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Memory impairment	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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