68H-19085-77788

2 vaccinations 11 coded responses 16 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 41-45
ZIP prefix: 641 / MO
Registered: 2021-06-14

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

2021-06-10
Dose 1 — Moderna
2021-06-14
Registered in v-safe
2021-06-14
Survey response — days 1–6 daily, dose 1
MedDRA: Fibromyalgia, Pre-existing disease — Feeling: Poor · Site: Pain, Itching · Fever · Chills, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Caused Fibromyalgia to flare up ever since

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-15
Survey response — days 1–6 daily, dose 1
MedDRA: Fibromyalgia, Pre-existing disease — Feeling: Fair · Site: Pain, Swelling, Itching · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Continued flare up of Fibromyalgia symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-16
Survey response — days 1–6 daily, dose 1
MedDRA: Condition aggravated, Gastrointestinal disorder, Gastrointestinal pain, Pre-existing disease, Rash, Self-medication, Urticaria — Feeling: Fair · Site: Itching · Muscle or body aches, Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Still causing fibromyalgia to flare, but less today. GI was severe for only a few hours and then stopped, to now just cramp. Rash was a sudden round of hives which mostly resolved with Benadryl, although bumps have yet to fully go down.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-17
Health check-in — day 7, dose 1
Feeling: Fair · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-06-24
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-07-01
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-07-08
Dose 2 — Moderna
2021-07-10
Survey response — days 1–6 daily, dose 2
MedDRA: Fibromyalgia, Pre-existing disease — Feeling: Poor · Site: Pain, Redness, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work or attend school

Free text: Acute fibromyalgia flare

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-11
Survey response — days 1–6 daily, dose 2
MedDRA: Brain fog, Condition aggravated, Dizziness, Pre-existing disease — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work or attend school

Free text: Acute fibromyalgia flare, lightheaded, brain fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-12
Survey response — days 1–6 daily, dose 2
MedDRA: Condition aggravated, Fibromyalgia, Insomnia, Pre-existing disease — Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Acute fibromyalgia flare, insomnia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-13
Survey response — days 1–6 daily, dose 2
MedDRA: Brain fog, Condition aggravated, Pre-existing disease, Pruritus — Feeling: Fair · Site: Swelling, Itching · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Fibromyalgia flare, brain fog, itchy palms and soles

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-14
Survey response — days 1–6 daily, dose 2
MedDRA: Condition aggravated, Dizziness, Migraine, Pre-existing disease — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Fibromyalgia flare, migraine, nearly passed out from attempting mild exertion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-15
Survey response — day 7, dose 2
MedDRA: Condition aggravated, Dizziness, Pre-existing disease, Somnolence — Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Acute fibromyalgia flare continues, lightheadedness, somnolence

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-24
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-08-02
Survey response — day 21, dose 2
MedDRA: Condition aggravated, Pre-existing disease, Sinusitis — Feeling: Fair · 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

Free text: Hashimotos Disease has flared up and developed a sinus infection.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-02
Report sent to call center — day 21, 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

1 call case(s)
2021-08-07
Survey response — day 28, dose 2
MedDRA: Condition aggravated, Pre-existing disease, Sinusitis — Feeling: Fair · Be unable to do your normal daily activities

Free text: Im not sure if I all ready put it, since it feels like forever, but I developed a sinus infection requiring antibiotics on top of the fibromyalgia flare up

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-12
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-08-13
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-06-10	Moderna
2	2021-07-08	Moderna	No

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 9 — days 1–6 daily, dose 1

2021-06-14

Systemic reaction (other): Caused Fibromyalgia to flare up ever since

2021-06-15

Systemic reaction (other): Continued flare up of Fibromyalgia symptoms

2021-06-16

Systemic reaction (other): Still causing fibromyalgia to flare, but less today. GI was severe for only a few hours and then stopped, to now just cramp. Rash was a sudden round of hives which mostly resolved with Benadryl, although bumps have yet to fully go down.

Release 9 — days 1–6 daily, dose 2

2021-07-10

Systemic reaction (other): Acute fibromyalgia flare

2021-07-11

Systemic reaction (other): Acute fibromyalgia flare, lightheaded, brain fog

2021-07-12

Systemic reaction (other): Acute fibromyalgia flare, insomnia

2021-07-13

Systemic reaction (other): Fibromyalgia flare, brain fog, itchy palms and soles

2021-07-14

Systemic reaction (other): Fibromyalgia flare, migraine, nearly passed out from attempting mild exertion

Release 9 — day 7, dose 2

2021-07-15

Systemic reaction (other): Acute fibromyalgia flare continues, lightheadedness, somnolence

Release 9 — day 21, dose 2

2021-08-02

Symptoms: Hashimotos Disease has flared up and developed a sinus infection.

Release 9 — day 28, dose 2

2021-08-07

Symptoms: Im not sure if I all ready put it, since it feels like forever, but I developed a sinus infection requiring antibiotics on top of the fibromyalgia flare up

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	Condition aggravated	✓	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Sinusitis	✓	·	✓
SRO	Brain fog	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Fibromyalgia	✓	✓	✓
SRO	Gastrointestinal disorder	✓	✓	✓
SRO	Gastrointestinal pain	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Migraine	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Somnolence	✓	·	✓
SRO	Urticaria	✓	✓	✓

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