4MB-30265-87674

2 vaccinations 8 coded responses 12 check-ins 8 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 461 / IN
Registered: 2021-03-01

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

2021-01-29
Dose 1 — Moderna
2021-02-26
Dose 2 — Moderna
2021-03-01
Registered in v-safe
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Loss of personal independence in daily activities, Mobility decreased — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Extremely painful shoulder. Symptoms were severe night of injection for at least 36 hours. I was unable to move my arm enough to dress.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Arthropathy, Musculoskeletal discomfort, Product administered at inappropriate site — Feeling: Fair · Site: Pain · Joint pains · Be unable to do your normal daily activities

Free text: Just my shoulder. Injection was administered way to high. I took a photo of where she placed bandaid. Could she have injured my shoulder?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in extremity — Feeling: Fair · Site: Pain

Free text: Arm is still painful but almost normal range of motion and ADL

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain, Pain — Feeling: Fair · Site: Pain · Muscle or body aches

Free text: Injection site, shoulder and arm still ache, especially with movement. I still cant lie on affected arm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — day 7, dose 2
MedDRA: Movement disorder, Sleep disorder — Feeling: Fair · Site: Pain · Muscle or body aches

Free text: Im still unable to sleep on my arm or raise my arm over my head. Is this normal?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — day 14, dose 2
MedDRA: Arthralgia, Back pain, Bursitis, Pain, Pain in extremity, Physiotherapy, Product administered at inappropriate site, Stress — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Ongoing pain in left shoulder and arm. Covid injection given too high. Severe bursitis. Stress and pain resulting in lower back pain. I will require specialist, steroid injection and physical therapy. · Healthcare visit (other): Steroid injection, physical therapy and pain medication.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Report sent to call center — day 14, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Survey response — day 21, dose 2
MedDRA: Shoulder injury related to vaccine administration, Unevaluable event — Feeling: Poor · Be unable to work, 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: Diagnosed with sirva · Healthcare visit (other): Steroid injection in effected shoulder

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Report sent to call center — day 21, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-26
Survey response — day 28, dose 2
MedDRA: Arthralgia, Office visit — Feeling: Fair · Be unable to work, 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: Symptoms: Have begun physical therapy on injured shoulder. · Healthcare visit (other): Physical therapy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Report sent to call center — day 28, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-02
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-09
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-29
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-28
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-03-04
Call 1 — Left Voicemail
2022-03-07
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-29	Moderna
2	2021-02-26	Moderna

Call center

3 call center cases

3 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-03-01

Systemic reaction (other): Extremely painful shoulder. Symptoms were severe night of injection for at least 36 hours. I was unable to move my arm enough to dress.

2021-03-02

Systemic reaction (other): Just my shoulder. Injection was administered way to high. I took a photo of where she placed bandaid. Could she have injured my shoulder?

Release 5 — days 1–6 daily, dose 2

2021-03-03

Systemic reaction (other): Arm is still painful but almost normal range of motion and ADL

2021-03-04

Systemic reaction (other): Injection site, shoulder and arm still ache, especially with movement. I still cant lie on affected arm.

Release 5 — day 7, dose 2

2021-03-05

Systemic reaction (other): Im still unable to sleep on my arm or raise my arm over my head. Is this normal?

Release 5 — day 14, dose 2

2021-03-12

Symptoms: Ongoing pain in left shoulder and arm. Covid injection given too high. Severe bursitis. Stress and pain resulting in lower back pain. I will require specialist, steroid injection and physical therapy.

Healthcare visit (other): Steroid injection, physical therapy and pain medication.

Release 5 — day 21, dose 2

2021-03-19

Symptoms: Diagnosed with sirva

Healthcare visit (other): Steroid injection in effected shoulder

Release 6 — day 28, dose 2

2021-03-26

Symptoms: Have begun physical therapy on injured shoulder.

Healthcare visit (other): Physical therapy

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	Office visit	✓	✓	✓
HCVO	Physiotherapy	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Bursitis	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Product administered at inappropriate site	✓	✓	✓
SD	Shoulder injury related to vaccine administration	✓	✓	✓
SD	Stress	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Arthropathy	·	·	✓
SRO	Injection site pain	✓	✓	✓
SRO	Loss of personal independence in daily activities	✓	✓	✓
SRO	Mobility decreased	✓	✓	✓
SRO	Movement disorder	✓	✓	✓
SRO	Musculoskeletal discomfort	✓	✓	○
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Product administered at inappropriate site	·	·	✓
SRO	Sleep disorder	✓	✓	✓

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