694-10574-21678

Timeline

1. 2021-01-15
   Registered in v-safe
2. 2021-01-15
   Dose 1 — Moderna
3. 2021-01-16
   Health check-in — days 1–6 daily, dose 1

   Feeling: Good · Joint pains, Muscle or body aches

   Adult check-in
4. 2021-01-17
   Health check-in — days 1–6 daily, dose 1

   Feeling: Good · None

   Adult check-in
5. 2021-01-18
   Health check-in — days 1–6 daily, dose 1

   Feeling: Good · None

   Adult check-in
6. 2021-01-19
   Health check-in — days 1–6 daily, dose 1

   Feeling: Good · None

   Adult check-in
7. 2021-01-21
   Health check-in — days 1–6 daily, dose 1

   Feeling: Good · None

   Adult check-in
8. 2021-01-22
   Survey response — day 7, dose 1

   MedDRA: Emergency care, Fall, Fracture, Pain, Rib fracture — Feeling: Good · Joint pains · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

   Free text: Systemic reaction (other): Fell on the 18th, went to urgent care and told fractured rib and spine. Very sore. · Healthcare visit (other): All is well with covid vaccine. No side affects. Issue is the fall and soreness stiffness difficulty getting out of bed. Painful.

   MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
9. 2021-01-22
   Report sent to call center — day 7, dose 1

   Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

   1 call case(s)
10. 2021-01-29
    Survey response — day 14, dose 1

    MedDRA: Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

    Free text: Nothing related to Covid. Fall on the 18, slip on the 23rd.

    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
11. 2021-01-29
    Report sent to call center — day 14, dose 1

    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

    1 call case(s)
12. 2021-02-05
    Survey response — day 21, dose 1

    MedDRA: Back disorder, Fall, Pain, Pain in extremity — Feeling: Good · Be unable to do your normal daily activities

    Free text: Back issues, left arm and all of left side pain due to fall.

    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
13. 2021-02-12
    Dose 2 — Moderna
14. 2021-02-19
    Survey response — day 7, dose 2

    MedDRA: Nasopharyngitis — Feeling: Good · Site: Redness · Chills

    Free text: Cold

    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
15. 2021-05-12
    Call successful

    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
16. 2021-08-13
    Survey response — 6 months, dose 2

    MedDRA: Fall, Office visit, Rash — Feeling: Good · 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: Fell a few times and currently have a rash near private area. · Healthcare visit (other): First my dr who provided cream but did not help then urgent care who did nothing.

    MedDRA releases: 2021-09,2024-11 · check-in free text available
17. 2021-08-13
    Report sent to call center — 6 months, dose 2

    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

    1 call case(s)
18. 2021-08-18
    Call successful

    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)