3QJ-12191-05406
5 vaccinations
5 coded responses
57 check-ins
5 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 930 / CA
- Registered
- 2021-03-15
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-15
Registered in v-safe
-
2021-03-15
Dose 1 — Moderna
-
2021-03-15
Health check-in — day 0, dose 1Feeling: Good · Site: Pain · Headache, Fatigue or tirednessAdult check-in
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-20
- 2021-03-21
- 2021-03-22
-
2021-03-29
Survey response — day 14, dose 1MedDRA: Injected limb mobility decreased, Injection site pain, Muscular weakness — Feeling: Good · Be unable to do your normal daily activitiesFree text: At injection site: My right shoulder/rotator cuff pain with reduced range of motion and muscle weakness.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-05
Survey response — day 21, dose 1MedDRA: Asthenia, Injection site joint pain, Joint range of motion decreased — 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 visitFree text: Injection site shoulder joint pain, reduced range of motion, weakness.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-05
Report sent to call center — day 21, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-04-12
Dose 2 — Moderna
-
2021-04-12
Health check-in — day 0, dose 2Feeling: Good · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-04-13
- 2021-04-14
- 2021-04-15
- 2021-04-16
- 2021-04-17
-
2021-04-19
Survey response — day 7, dose 2MedDRA: Rotator cuff syndrome — Feeling: GoodFree text: I am still recovering from the effect of the first shot with rotator cuff injury. Second shot was perfectly delivered.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-26
- 2021-05-03
- 2021-05-12
- 2021-05-17
- 2021-05-24
- 2021-07-12
- 2021-10-11
-
2021-10-27
Dose 3 — Moderna
-
2021-10-27
Survey response — day 0, dose 3MedDRA: Shoulder injury related to vaccine administration — Feeling: GoodFree text: Still have SIRVA from my first vaccine shot in March 2021MedDRA releases: 2024-11 · check-in free text available
-
2021-10-28
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-11
- 2021-11-17
- 2021-11-24
- 2021-12-01
- 2021-12-08
- 2022-01-26
- 2022-03-16
- 2022-04-27
-
2022-04-27
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-04-28
Dose 4 — Moderna
-
2022-04-29
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2022-04-30
- 2022-05-01
- 2022-05-02
- 2022-05-03
- 2022-05-05
- 2022-05-12
- 2022-05-21
- 2022-05-26
- 2022-06-04
- 2022-06-11
-
2022-09-25
Dose 5 — Moderna
- 2022-10-13
- 2022-10-18
- 2022-10-23
- 2022-10-30
- 2022-11-06
-
2022-12-25
Health check-in — 3 months, dose 5Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Headaches, body aches, severe coughing, sneezing, fever, runny nose.Adult check-in · check-in free text available
- 2022-12-25
- 2022-12-27
-
2023-03-26
Survey response — 6 months, dose 5MedDRA: Fatigue, Pain, Pyrexia, Respiratory tract infection viral — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-03-26
Report sent to call center — 6 months, dose 5Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2023-03-27
- 2023-03-27
- 2023-03-28
- 2023-03-28
-
2023-03-28
Callback requested for04:00PM ET
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-15 | Moderna | |
| 2 | 2021-04-12 | Moderna | |
| 3 | 2021-10-27 | Moderna | No |
| 4 | 2022-04-28 | Moderna | No |
| 5 | 2022-09-25 | Moderna | No |
Call center
3 call center cases
1 successful · 2 unsuccessful
1 wait over 3 months for a first call
Free text
Release 6 — day 14, dose 1
Symptoms: At injection site: My right shoulder/rotator cuff pain with reduced range of motion and muscle weakness.
Release 6 — day 21, dose 1
Symptoms: Injection site shoulder joint pain, reduced range of motion, weakness.
Release 7 — day 7, dose 2
Systemic reaction (other): I am still recovering from the effect of the first shot with rotator cuff injury. Second shot was perfectly delivered.
Release 10 — day 0, dose 3
Systemic reaction (other): Still have SIRVA from my first vaccine shot in March 2021
Release 12 — 3 months, dose 5
Symptoms: Headaches, body aches, severe coughing, sneezing, fever, runny nose.
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 | Asthenia | ✓ | ✓ | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Injected limb mobility decreased | ✓ | ✓ | ✓ |
| SD | Injection site joint pain | ✓ | ✓ | ✓ |
| SD | Injection site pain | ✓ | ✓ | ✓ |
| SD | Joint range of motion decreased | ✓ | ✓ | ✓ |
| SD | Muscular weakness | ✓ | ✓ | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Respiratory tract infection viral | · | · | ✓ |
| SRO | Rotator cuff syndrome | ✓ | ✓ | ✓ |
| SRO | Shoulder injury related to vaccine administration | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release