6YS-76149-17921

2 vaccinations 9 coded responses 13 check-ins 9 free-text entries 0 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 076 / NJ
Registered: 2021-02-28

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

2021-02-27
Dose 1 — Moderna
2021-02-28
Registered in v-safe
2021-03-30
Dose 2 — Moderna
2021-03-31
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-01
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Fatigue, Insomnia, Restlessness — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: I wasn't able to register for 1st shot..with that I had chills and very tired for several hours adter shot..not bad the 2nd day. This time it seems 1st night, though tired, struggled to sleep and last night slept but very disrupted and restless. both nights

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Insomnia — Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: These symptoms may be due to my chronic health conditions and not the vaccine..still had issues with sleep last night

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — days 1–6 daily, dose 2
MedDRA: Condition aggravated, Feeling abnormal, Pre-existing disease — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Free text: I have had a history with either lymph or cyst pain..never accurately diagnosed. I've always susoected "infection" or whatever. Anyway, it's a spot to the back of my breast by the ribs below my arm pit. The symptoms are kicking up a bit. May be coincidental..don't know. And my chronic brain fog is pretty extreme lately. Vaxx or food. Who knows?!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: I think my symptoms today are due to poor nutrition especially with the holiday food yesterday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — day 7, dose 2
MedDRA: Atrial fibrillation, Feeling abnormal, Sleep disorder — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Disturbed sleep. Brain fog pretty se ere, but I've had chronic brain fod for 45 years..just very bad today. Not sure if occasional A-fib flutters and skips the past few days is vaccine-related.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — day 14, dose 2
MedDRA: Atrial fibrillation, Condition aggravated — Feeling: Fair

Free text: My afib is kicking up.. no idea why. Doubt it is vaxx-related, but am mentioning it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-27
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-04
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-05-12
Survey response — day 42, dose 2
MedDRA: Headache — Feeling: Fair

Free text: Don't know if it is vax-related..hormo es and sleep issues worsening. Facial hair (not that I like it) suddenly stopped growing. Could be other chronic stuff.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-29
Survey response — 3 months, dose 2
MedDRA: Brain fog, COVID-19, Memory impairment, Pain — Feeling: Fair

Free text: Not sure if new or worsening symptoms related to vax, an unknown(but suspected)exposure to COVID in March2020 or just my declining health generally.Chronic brain fog/memory worse than ever, odd, varying pains, etc. Add don't knowto last question.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-28
Survey response — 6 months, dose 2
MedDRA: Brain fog, Neck pain, Oropharyngeal pain — Feeling: Fair

Free text: More brain issues..fog much worse..pains in throat and neck..not sure of source..brain could be EMF exposure..throat could be dental-rated..all big ???

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-27	Moderna
2	2021-03-30	Moderna

Free text

Release 6 — days 1–6 daily, dose 2

2021-04-01

Systemic reaction (other): I wasn't able to register for 1st shot..with that I had chills and very tired for several hours adter shot..not bad the 2nd day. This time it seems 1st night, though tired, struggled to sleep and last night slept but very disrupted and restless. both nights

2021-04-02

Systemic reaction (other): These symptoms may be due to my chronic health conditions and not the vaccine..still had issues with sleep last night

2021-04-03

Systemic reaction (other): I have had a history with either lymph or cyst pain..never accurately diagnosed. I've always susoected "infection" or whatever. Anyway, it's a spot to the back of my breast by the ribs below my arm pit. The symptoms are kicking up a bit. May be coincidental..don't know. And my chronic brain fog is pretty extreme lately. Vaxx or food. Who knows?!

Release 7 — days 1–6 daily, dose 2

2021-04-05

Systemic reaction (other): I think my symptoms today are due to poor nutrition especially with the holiday food yesterday.

Release 7 — day 7, dose 2

2021-04-06

Systemic reaction (other): Disturbed sleep. Brain fog pretty se ere, but I've had chronic brain fod for 45 years..just very bad today. Not sure if occasional A-fib flutters and skips the past few days is vaccine-related.

Release 7 — day 14, dose 2

2021-04-15

Symptoms: My afib is kicking up.. no idea why. Doubt it is vaxx-related, but am mentioning it.

Release 8 — day 42, dose 2

2021-05-12

Symptoms: Don't know if it is vax-related..hormo es and sleep issues worsening. Facial hair (not that I like it) suddenly stopped growing. Could be other chronic stuff.

Release 9 — 3 months, dose 2

2021-06-29

Symptoms: Not sure if new or worsening symptoms related to vax, an unknown(but suspected)exposure to COVID in March2020 or just my declining health generally.Chronic brain fog/memory worse than ever, odd, varying pains, etc. Add don't knowto last question.

Release 9 — 6 months, dose 2

2021-09-28

Symptoms: More brain issues..fog much worse..pains in throat and neck..not sure of source..brain could be EMF exposure..throat could be dental-rated..all big ???

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	Atrial fibrillation	✓	✓	✓
SD	Brain fog	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	COVID-19	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Memory impairment	✓	✓	✓
SD	Neck pain	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Atrial fibrillation	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Restlessness	✓	✓	✓
SRO	Sleep disorder	✓	✓	✓

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