58X-19188-86238

2 vaccinations 11 coded responses 19 check-ins 11 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 021 / MA
Registered: 2021-03-22

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

2021-03-14
Dose 1 — Moderna
2021-03-22
Registered in v-safe
2021-03-22
Survey response — day 7, dose 1
MedDRA: Disorientation — Feeling: Fair · Site: Pain, Redness, Itching · Fatigue or tiredness

Free text: Disoriented thinking. It took me 25 minutes to realize it is 2021 and not 2022. Has never happened before

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Survey response — day 14, dose 1
MedDRA: Drainage, Oropharyngeal pain — Feeling: Good

Free text: Edge of a sore throat maybe due to drainage/ seasonal allergies

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-11
Dose 2 — Moderna
2021-04-11
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · None

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains

Adult check-in
2021-04-17
Survey response — days 1–6 daily, dose 2
MedDRA: Loss of personal independence in daily activities, Muscle disorder, Muscle spasms, Pain in extremity — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities

Free text: My arm where I had my first shot is very sore. Has been for two weeks. Limiting - or putting shirt on, drying back with a towel. It feels like a spasm or a muscle catch.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-18
Survey response — day 7, dose 2
MedDRA: Pain, Pain in extremity — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities

Free text: Upper left arm is very sore when moving

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Survey response — day 14, dose 2
MedDRA: Mobility decreased, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: I am having more pain in the upper arm where I had the first shot. It is hard to put a shirt on.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-09
Survey response — day 28, dose 2
MedDRA: Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: My upper arm continues to hurt.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Survey response — day 35, dose 2
MedDRA: Arthralgia, Injection site mass, Pain in extremity — 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 left arm and shoulder are painful. I received my first Moderna shot in that arm. Developed a lump day 8.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-23
Survey response — day 42, dose 2
MedDRA: Arthralgia, Pain in extremity, Unevaluable event — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Symptoms: The shoulder and upper arm pain has increased in my left arm. The pain started 8 days after my first Moderna shot on March 11th and has increased. · Healthcare visit (other): I went for an MRI

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-12
Survey response — 3 months, dose 2
MedDRA: Injection site mass, Injection site pain, Injection site rash, Periarthritis — Feeling: Fair · 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: The arm I had my first Maderna vaccination was diagnosed as Frozen Shoulder. The upper arm pain started 8 days after my first shot. I also had a rash and lump. Think nurse injected shot incorrectly causing issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-12
Report sent to call center — 3 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

1 call case(s)
2021-07-16
Call 1 — Left Voicemail
2021-07-16
Call successful
Does not wish to fill out VAERS report
2021-10-12
Survey response — 6 months, dose 2
MedDRA: Periarthritis, Physiotherapy — Feeling: Fair · 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: My left shoulder became frozen 8 days after my first vaccination. I am working with PT to release the shoulder. · Healthcare visit (other): Weekly PT since August

MedDRA releases: 2024-11 · check-in free text available
2021-10-12
Report sent to call center — 6 months, 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)
2021-10-14
Call 1 — Could Not Reach Participant
2021-10-19
Call 2 — Could Not Reach Participant
2022-04-12
Survey response — 12 months, dose 2
MedDRA: Abdominal discomfort, Diarrhoea, Fatigue, Gastroenteritis viral, Gastrooesophageal reflux disease, Headache, Muscle spasms — Feeling: Poor · Be unable to do your normal daily activities

Free text: Stomach bug and slight headache. The diarrhea and cramps were very bad last night. Today very tired with some distress and reflux after eating

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-14	Moderna
2	2021-04-11	Moderna

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 6 — day 7, dose 1

2021-03-22

Systemic reaction (other): Disoriented thinking. It took me 25 minutes to realize it is 2021 and not 2022. Has never happened before

Release 6 — day 14, dose 1

2021-03-28

Symptoms: Edge of a sore throat maybe due to drainage/ seasonal allergies

Release 7 — days 1–6 daily, dose 2

2021-04-17

Systemic reaction (other): My arm where I had my first shot is very sore. Has been for two weeks. Limiting - or putting shirt on, drying back with a towel. It feels like a spasm or a muscle catch.

Release 7 — day 7, dose 2

2021-04-18

Systemic reaction (other): Upper left arm is very sore when moving

Release 7 — day 14, dose 2

2021-04-25

Symptoms: I am having more pain in the upper arm where I had the first shot. It is hard to put a shirt on.

Release 8 — day 28, dose 2

2021-05-09

Symptoms: My upper arm continues to hurt.

Release 8 — day 35, dose 2

2021-05-18

Symptoms: My left arm and shoulder are painful. I received my first Moderna shot in that arm. Developed a lump day 8.

Release 8 — day 42, dose 2

2021-05-23

Symptoms: The shoulder and upper arm pain has increased in my left arm. The pain started 8 days after my first Moderna shot on March 11th and has increased.

Healthcare visit (other): I went for an MRI

Release 9 — 3 months, dose 2

2021-07-12

Symptoms: The arm I had my first Maderna vaccination was diagnosed as Frozen Shoulder. The upper arm pain started 8 days after my first shot. I also had a rash and lump. Think nurse injected shot incorrectly causing issues

Release 10 — 6 months, dose 2

2021-10-12

Symptoms: My left shoulder became frozen 8 days after my first vaccination. I am working with PT to release the shoulder.

Healthcare visit (other): Weekly PT since August

Release 11 — 12 months, dose 2

2022-04-12

Symptoms: Stomach bug and slight headache. The diarrhea and cramps were very bad last night. Today very tired with some distress and reflux after eating

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	·	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Abdominal discomfort	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Diarrhoea	·	·	✓
SD	Drainage	○	✓	○
SD	Fatigue	·	·	✓
SD	Gastroenteritis viral	·	·	✓
SD	Gastrooesophageal reflux disease	·	·	✓
SD	Headache	·	·	✓
SD	Injection site mass	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Mobility decreased	✓	✓	✓
SD	Muscle spasms	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Periarthritis	✓	✓	✓
SD	Physiotherapy	·	·	✓
SRO	Disorientation	✓	✓	✓
SRO	Loss of personal independence in daily activities	✓	✓	✓
SRO	Muscle disorder	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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