65B-13021-00760
3 vaccinations
4 coded responses
37 check-ins
4 free-text entries
1 call case
- Sex
- —
- Age at first dose
- 66+
- ZIP prefix
- 890 / NV
- Registered
- 2021-02-17
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-17
Registered in v-safe
-
2021-02-17
Dose 1 — Moderna
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-20
- 2021-02-21
- 2021-02-22
- 2021-02-23
- 2021-02-24
- 2021-03-03
- 2021-03-10
- 2021-03-17
-
2021-03-19
Dose 2 — Moderna
-
2021-03-24
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue, Middle insomnia, Night sweats, Pain in extremity, Self-medication — Feeling: Good · Site: Redness, SwellingFree text: After the shot on Friday afternoon, I felt tired until Monday. Also, I woke up on Sunday with a sore upper arm on my right. The shot was on my left. I took 2 Ibuprofen and went to bed with a hot water bottle. I didnt think I had fever, but I woke up twice damp all over and had to change my pajamas. I guess they were night sweats. After that, I was fine on Monday the 22nd and ever since.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-25
- 2021-03-26
- 2021-04-02
- 2021-04-09
- 2021-04-16
- 2021-04-24
- 2021-04-30
- 2021-06-18
- 2021-09-17
-
2021-10-28
Dose 3 — Moderna
- 2021-10-28
-
2021-10-29
Survey response — days 1–6 daily, dose 3MedDRA: Injection site pain — Feeling: GoodFree text: The site where the shot was given is just a little sore, but much better today.MedDRA releases: 2024-11 · check-in free text available
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-11
- 2021-11-18
- 2021-11-25
- 2021-12-02
- 2021-12-09
- 2022-01-27
-
2022-04-28
Survey response — 6 months, dose 3MedDRA: Back pain, Emergency care, Presyncope, Spinal fracture, Urinary tract infection — Feeling: FairFree text: I had a UTI when I got the second booster, but didn't know it. 2 days later I almost fainted and had excruciating back pain. I thought it was the booster shot, but the hospital has found a fracture in my back. So it wasn't the shot.MedDRA releases: 2024-11 · check-in free text available
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2022-10-28
Survey response — 12 months, dose 3MedDRA: Back disorder, Fractured coccyx, Lumbar vertebral fracture, Pain, Pre-existing disease, Spondylolisthesis, Syncope — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, HospitalizationFree text: Symptoms: I fainted 2 days after my 2nd Covid Booster shot. I believe it was because I had a UTI and didn't know it when I got the shot. I fractured my tailbone, L 1 fracture and L5 par fracture. The L5 par fracture may never get better. Pain when walking. · Healthcare visit (other): My health is ok except for my back. I now have spondylolethes from my L 5 fracture.MedDRA releases: 2024-11 · check-in free text available
-
2022-10-28
Report sent to call center — 12 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2022-10-31
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-17 | Moderna | |
| 2 | 2021-03-19 | Moderna | |
| 3 | 2021-10-28 | Moderna | No |
Call center
1 call center case
1 unsuccessful
Free text
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): After the shot on Friday afternoon, I felt tired until Monday. Also, I woke up on Sunday with a sore upper arm on my right. The shot was on my left. I took 2 Ibuprofen and went to bed with a hot water bottle. I didnt think I had fever, but I woke up twice damp all over and had to change my pajamas. I guess they were night sweats. After that, I was fine on Monday the 22nd and ever since.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): The site where the shot was given is just a little sore, but much better today.
Release 11 — 6 months, dose 3
Symptoms: I had a UTI when I got the second booster, but didn't know it. 2 days later I almost fainted and had excruciating back pain. I thought it was the booster shot, but the hospital has found a fracture in my back. So it wasn't the shot.
Release 12 — 12 months, dose 3
Symptoms: I fainted 2 days after my 2nd Covid Booster shot. I believe it was because I had a UTI and didn't know it when I got the shot. I fractured my tailbone, L 1 fracture and L5 par fracture. The L5 par fracture may never get better. Pain when walking. cut off by CDC
Healthcare visit (other): My health is ok except for my back. I now have spondylolethes from my L 5 fracture.
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 | Back disorder | · | · | ✓ |
| HCVO | Lumbar vertebral fracture | · | · | ✓ |
| HCVO | Spondylolisthesis | · | · | ✓ |
| SD | Back pain | · | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Fractured coccyx | · | · | ✓ |
| SD | Lumbar vertebral fracture | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Presyncope | · | · | ✓ |
| SD | Spinal fracture | · | · | ✓ |
| SD | Syncope | · | · | ✓ |
| SD | Urinary tract infection | · | · | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Injection site pain | · | · | ✓ |
| SRO | Middle insomnia | ✓ | ✓ | ✓ |
| SRO | Night sweats | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release