4DM-58107-86361

2 vaccinations 12 coded responses 18 check-ins 12 free-text entries 4 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 959 / CA
Registered: 2021-10-11

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

Timeline

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

2021-10-07
Dose 1 — Moderna
2021-10-11
Registered in v-safe
2021-10-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-10-12
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Continued chest pain that started the day after vaccination

MedDRA releases: 2024-11 · check-in free text available
2021-10-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-10-15
Survey response — day 7, dose 1
MedDRA: Chest pain — Feeling: Good · Site: Pain · Joint pains, Fatigue or tiredness

Free text: Continued chest pain

MedDRA releases: 2024-11 · check-in free text available
2021-10-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-10-28
Survey response — day 21, dose 1
MedDRA: Arthralgia, Loss of personal independence in daily activities, Mobility decreased — Feeling: Fair · Be unable to do your normal daily activities

Free text: Shoulder pain has increased to the point that it's sometimes difficult to raise my arm in order to perform ADLs.

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Dose 2 — Janssen/Johnson & Johnson
2021-11-05
Survey response — day 28, dose 1
MedDRA: Arthralgia, Back pain, Headache, Myalgia, Neck pain — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: The muscle and joint pain in my left shoulder, left upper back and neck along with the headache that I developed right after the injection have gotten much worse.

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Report sent to call center — day 28, dose 1
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-11-06
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-11-08
Call 1 — Could Not Reach Participant
2021-11-09
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-11-11
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Pain — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Sharp pain radiating from shoulder into clavicle

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Call 2 — Left Voicemail
2021-11-14
Survey response — day 7, dose 2
MedDRA: Bone pain — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Bone pain from my clavicle around my shoulder and into my shoulder blade

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Survey response — day 14, dose 2
MedDRA: Arthralgia, Joint range of motion decreased, Physiotherapy — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: My shoulder pain has increased drastically and I've lost range of motion in spite of doing stretches prescribed by PT 3-4 times every day.

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-11-23
Call 1 — Left Voicemail
2021-11-27
Survey response — day 21, dose 2
MedDRA: Arthralgia, Joint range of motion decreased, Muscular weakness, Physiotherapy — Feeling: Poor · 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: My shoulder pain and weakness have worsened and I've lost more range of motion in spite of doing my physical therapy stretches every day.

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-01
Call 1 — Left Voicemail
2021-12-04
Survey response — day 28, dose 2
MedDRA: Asthenia, Shoulder girdle pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: The shoulder girdle pain and weakness have gotten worse.

MedDRA releases: 2024-11 · check-in free text available
2021-12-11
Survey response — day 35, dose 2
MedDRA: Arthralgia, Joint range of motion decreased, Physiotherapy — Feeling: Fair · Be unable to do your normal daily activities

Free text: My shoulder pain has increased and my range of motion has decreased despite continuing with my physical therapy.

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Survey response — day 42, dose 2
MedDRA: Arthralgia, Joint range of motion decreased, Nausea — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: With my shoulder, I've lost more range of motion and the pain has increased to the point that it's making me nauseous.

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-21
Call 1 — Left Voicemail
2022-02-04
Health check-in — 3 months, dose 2
Feeling: Poor

Adult check-in
2022-05-06
Survey response — 6 months, dose 2
MedDRA: COVID-19, Respiratory disorder — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: A COVID-19 infection that has left me with breathing problems leaving me with the diagnosis of long covid.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-10-07	Moderna	No
2	2021-11-05	Janssen/Johnson & Johnson	No

Call center

4 call center cases

4 unsuccessful

VAERS report filed, before or during a call: 3

See the call center timeline

Free text

Release 10 — days 1–6 daily, dose 1

2021-10-12

Systemic reaction (other): Continued chest pain that started the day after vaccination

Release 10 — day 7, dose 1

2021-10-15

Systemic reaction (other): Continued chest pain

Release 10 — day 21, dose 1

2021-10-28

Symptoms: Shoulder pain has increased to the point that it's sometimes difficult to raise my arm in order to perform ADLs.

Release 10 — day 28, dose 1

2021-11-05

Symptoms: The muscle and joint pain in my left shoulder, left upper back and neck along with the headache that I developed right after the injection have gotten much worse.

Release 10 — days 1–6 daily, dose 2

2021-11-11

Systemic reaction (other): Sharp pain radiating from shoulder into clavicle

Release 10 — day 7, dose 2

2021-11-14

Systemic reaction (other): Bone pain from my clavicle around my shoulder and into my shoulder blade

Release 10 — day 14, dose 2

2021-11-19

Symptoms: My shoulder pain has increased drastically and I've lost range of motion in spite of doing stretches prescribed by PT 3-4 times every day.

Release 10 — day 21, dose 2

2021-11-27

Symptoms: My shoulder pain and weakness have worsened and I've lost more range of motion in spite of doing my physical therapy stretches every day.

Release 10 — day 28, dose 2

2021-12-04

Symptoms: The shoulder girdle pain and weakness have gotten worse.

Release 10 — day 35, dose 2

2021-12-11

Symptoms: My shoulder pain has increased and my range of motion has decreased despite continuing with my physical therapy.

Release 10 — day 42, dose 2

2021-12-17

Symptoms: With my shoulder, I've lost more range of motion and the pain has increased to the point that it's making me nauseous.

Release 11 — 6 months, dose 2

2022-05-06

Symptoms: A COVID-19 infection that has left me with breathing problems leaving me with the diagnosis of long covid.

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	Arthralgia	·	·	✓
SD	Asthenia	·	·	✓
SD	Back pain	·	·	✓
SD	COVID-19	·	·	✓
SD	Headache	·	·	✓
SD	Joint range of motion decreased	·	·	✓
SD	Loss of personal independence in daily activities	·	·	✓
SD	Mobility decreased	·	·	✓
SD	Muscular weakness	·	·	✓
SD	Myalgia	·	·	✓
SD	Nausea	·	·	✓
SD	Neck pain	·	·	✓
SD	Physiotherapy	·	·	✓
SD	Respiratory disorder	·	·	✓
SD	Shoulder girdle pain	·	·	✓
SRO	Arthralgia	·	·	✓
SRO	Bone pain	·	·	✓
SRO	Chest pain	·	·	✓
SRO	Pain	·	·	✓

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