3U9-27627-22818

4 vaccinations 12 coded responses 29 check-ins 11 free-text entries 2 call cases

Sex: Male
Age at first dose: 46-50
ZIP prefix: 919 / CA
Registered: 2021-03-27

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-03-27
Registered in v-safe
2021-03-27
Dose 1 — Moderna
2021-03-27
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-28
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-03
Health check-in — day 7, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-04-10
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-17
Survey response — day 21, dose 1
MedDRA: Pain in extremity — Feeling: Good · Be unable to do your normal daily activities

Free text: Arm pain has returned.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-27
Dose 2 — Moderna
2021-05-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-03
Survey response — days 1–6 daily, dose 2
MedDRA: Hot flush — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Hot flashes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Survey response — day 7, dose 2
MedDRA: Heart rate increased — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Increased resting heart rate (>90)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Survey response — day 14, dose 2
MedDRA: Heart rate increased, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Rapid resting heart rate (90-105 BPM)Arm still sore.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Survey response — day 21, dose 2
MedDRA: Joint range of motion decreased, Pain in extremity — Feeling: Good · Be unable to do your normal daily activities

Free text: Arm is still hurting, decreased range of motion as well.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-25
Survey response — day 28, dose 2
MedDRA: Arthralgia, Pain in extremity — Feeling: Good · Be unable to do your normal daily activities

Free text: Same pain in my arm/shoulder.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-01
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-27
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-10-26
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-12
Dose 3 — Moderna
2022-04-29
Survey response — 12 months, dose 2
MedDRA: Arthralgia, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: still having major shoulder/arm pain in the arm that I received my shots.

MedDRA releases: 2024-11 · check-in free text available
2022-09-17
Dose 4 — Moderna
2022-10-10
Survey response — day 21, dose 4
MedDRA: Arthralgia, Pain in extremity, Physiotherapy — 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 visit

Free text: Symptoms: Arm pain in shoulder and upper arm. This has been an issue since my second dose of the vaccine in April 2021 and has not gone away. · Healthcare visit (other): Physical therapy

MedDRA releases: 2024-11 · check-in free text available
2022-10-10
Report sent to call center — day 21, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-11
Call successful
Participant prefers to complete VAERS report online
2022-10-17
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-24
Survey response — day 35, dose 4
MedDRA: Arthralgia, Joint range of motion decreased — Feeling: Fair · Be unable to do your normal daily activities

Free text: Shoulder is still painful and has decreased range of motion.

MedDRA releases: 2024-11 · check-in free text available
2022-10-31
Survey response — day 42, dose 4
MedDRA: Arthralgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Shoulder still hurts

MedDRA releases: 2024-11 · check-in free text available
2022-12-17
Survey response — 3 months, dose 4
MedDRA: Chills, Headache, Nausea, Pain, Respiratory tract congestion, SARS-CoV-2 test positive — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Tested positive for COVID-19. Symptomatic with chills, body aches, headache, cough, congestion and nausea.

MedDRA releases: 2024-11 · check-in free text available
2023-03-18
Survey response — 6 months, dose 4
MedDRA: Cough — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-03-18
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2023-03-20
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-27	Moderna
2	2021-04-27	Moderna
3	2021-12-12	Moderna	No
4	2022-09-17	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 7 — day 21, dose 1

2021-04-17

Symptoms: Arm pain has returned.

Release 8 — days 1–6 daily, dose 2

2021-05-03

Systemic reaction (other): Hot flashes

Release 8 — day 7, dose 2

2021-05-04

Systemic reaction (other): Increased resting heart rate (>90)

Release 8 — day 14, dose 2

2021-05-11

Symptoms: Rapid resting heart rate (90-105 BPM)Arm still sore.

Release 8 — day 21, dose 2

2021-05-18

Symptoms: Arm is still hurting, decreased range of motion as well.

Release 8 — day 28, dose 2

2021-05-25

Symptoms: Same pain in my arm/shoulder.

Release 11 — 12 months, dose 2

2022-04-29

Symptoms: still having major shoulder/arm pain in the arm that I received my shots.

Release 12 — day 21, dose 4

2022-10-10

Symptoms: Arm pain in shoulder and upper arm. This has been an issue since my second dose of the vaccine in April 2021 and has not gone away.

Healthcare visit (other): Physical therapy

Release 12 — day 35, dose 4

2022-10-24

Symptoms: Shoulder is still painful and has decreased range of motion.

Release 12 — day 42, dose 4

2022-10-31

Symptoms: Shoulder still hurts

Release 12 — 3 months, dose 4

2022-12-17

Symptoms: Tested positive for COVID-19. Symptomatic with chills, body aches, headache, cough, congestion and nausea.

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	Physiotherapy	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Chills	·	·	✓
SD	Cough	·	·	✓
SD	Headache	·	·	✓
SD	Heart rate increased	✓	✓	✓
SD	Joint range of motion decreased	✓	✓	✓
SD	Nausea	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Respiratory tract congestion	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Hot flush	✓	✓	✓

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