4ZM-30436-54886

2 vaccinations 4 coded responses 22 check-ins 4 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 950 / CA
Registered: 2021-01-25

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

2021-01-22
Dose 1 — Moderna
2021-01-25
Registered in v-safe
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None · Be unable to do your normal daily activities

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-29
Health check-in — day 7, dose 1
Feeling: Fair · Site: Pain · None · Be unable to do your normal daily activities

Adult check-in
2021-02-05
Survey response — day 14, dose 1
MedDRA: Fatigue, Feeling abnormal, Headache, Movement disorder, Pain in extremity — 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

Free text: I think the nurse who gave me vaccine injected my shoulder joint. I cant lift my arm. Its very painful. Plus I feel crummy, headachey, fatigued.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Report sent to call center — day 14, dose 1
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)
2021-02-12
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-19
Dose 2 — Moderna
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Poor · Site: Pain, Redness · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Extreme fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Headache, Fatigue or tiredness · Be unable to work

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-23
Survey response — days 1–6 daily, dose 2
MedDRA: Wrong technique in product usage process — Feeling: Fair · Site: Pain · Be unable to work, Be unable to do your normal daily activities

Free text: My arm problems are secondary to the poor technique of vaccinator whi jabbed me in an active shoulder joint.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-26
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · None · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Adult check-in
2021-02-26
Report sent to call center — day 7, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-05
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-12
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-19
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-28
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-02
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-21
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-02
Call 1 — Left Voicemail
2021-08-20
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-19
Survey response — 12 months, dose 2
MedDRA: Polymyalgia rheumatica, Systemic inflammatory response syndrome — Feeling: 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Based on labs ordered by my dr. I seem to have a highly inflammatory response to booster · Healthcare visit (other): I seem to have developed polymyalgia rheumatica but the dx has been incertain because of high inflammatory reaponse and array of symptoms. I also had a full work up by Infectious Disease Dr

MedDRA releases: 2024-11 · check-in free text available
2022-02-19
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-24
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Moderna
2	2021-02-19	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 3 — day 14, dose 1

2021-02-05

Symptoms: I think the nurse who gave me vaccine injected my shoulder joint. I cant lift my arm. Its very painful. Plus I feel crummy, headachey, fatigued.

Release 4 — days 1–6 daily, dose 2

2021-02-20

Systemic reaction (other): Extreme fatigue

2021-02-23

Systemic reaction (other): My arm problems are secondary to the poor technique of vaccinator whi jabbed me in an active shoulder joint.

Release 11 — 12 months, dose 2

2022-02-19

Symptoms: Based on labs ordered by my dr. I seem to have a highly inflammatory response to booster

Healthcare visit (other): I seem to have developed polymyalgia rheumatica but the dx has been incertain because of high inflammatory reaponse and array of symptoms. I also had a full work up by Infectious Disease Dr

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	Polymyalgia rheumatica	·	·	✓
HCVO	Systemic inflammatory response syndrome	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Movement disorder	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Systemic inflammatory response syndrome	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Wrong technique in product usage process	✓	✓	✓

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