4AE-62936-26841
1 vaccination
7 coded responses
9 check-ins
7 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 970 / OR
- Registered
- 2021-02-28
- Relationship
- Self
- Race
- American Indian or Alaska Native
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-02-26
Dose 1 — Moderna
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2021-02-28
Registered in v-safe
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2021-02-28
Survey response — days 1–6 daily, dose 1MedDRA: Arthralgia — Feeling: Fair · Site: Pain · Be unable to do your normal daily activitiesFree text: Shoulder painMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-01
Survey response — days 1–6 daily, dose 1MedDRA: Arthralgia, Limb immobilisation — Feeling: Fair · Site: Pain · Be unable to do your normal daily activitiesFree text: Sore shoulder very hard to lift my armMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-02
Survey response — days 1–6 daily, dose 1MedDRA: Mobility decreased — Feeling: Fair · Site: Pain · Be unable to do your normal daily activitiesFree text: Unable to use my left arm for any strenuous activity.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-03
Survey response — days 1–6 daily, dose 1MedDRA: Loss of personal independence in daily activities, Mobility decreased — Feeling: Fair · Site: Pain · Be unable to do your normal daily activitiesFree text: Great difficulty raising my arm. Unable to do regular tasks.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-04
Survey response — days 1–6 daily, dose 1MedDRA: Arthralgia — Feeling: Fair · Site: Pain · Be unable to do your normal daily activitiesFree text: Shoulder pain, unable to swim with my left armMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-05
Survey response — day 7, dose 1MedDRA: Loss of personal independence in daily activities — Feeling: Fair · Site: Pain · Be unable to do your normal daily activitiesFree text: Unable to swim freestyle and backstroke. Before my shot I swam a mile a day.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-12
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2021-03-19
Survey response — day 21, dose 1MedDRA: Asthenia, Pain in extremity — Feeling: Good · Be unable to do your normal daily activitiesFree text: I slept in the vaccine site last Sunday and was in pain for the next two days. My left arm is still not back to full strength.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-08-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-26 | Moderna |
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Shoulder pain
Systemic reaction (other): Sore shoulder very hard to lift my arm
Systemic reaction (other): Unable to use my left arm for any strenuous activity.
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Great difficulty raising my arm. Unable to do regular tasks.
Systemic reaction (other): Shoulder pain, unable to swim with my left arm
Release 5 — day 7, dose 1
Systemic reaction (other): Unable to swim freestyle and backstroke. Before my shot I swam a mile a day.
Release 5 — day 21, dose 1
Symptoms: I slept in the vaccine site last Sunday and was in pain for the next two days. My left arm is still not back to full strength.
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 | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Limb immobilisation | ✓ | ✓ | ✓ |
| SRO | Loss of personal independence in daily activities | ✓ | ✓ | ✓ |
| SRO | Mobility decreased | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release