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5TM-33404-60013

3 vaccinations 3 coded responses 11 check-ins 3 free-text entries 1 call case
Sex
Male
Age at first dose
61-65
ZIP prefix
863 / AZ
Registered
2021-03-20
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-22
    Dose 1 — Moderna
  2. 2021-03-04
    Dose 2 — Moderna
  3. 2021-03-20
    Registered in v-safe
  4. 2021-03-20
    Survey response — day 14, dose 2
    MedDRA: Dizziness, Injection site discolouration, Injection site erythema, Injection site haemorrhage, Injection site pain — Feeling: Good
    Free text: When the vaccine was administered, I bled some. Had some reactions the next day (arm soreness, lightheaded) but was good the following day. Then a week later redness, stingy, and then a brown yellowish tint and now a greenish tint. It is improving
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-03-25
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  6. 2021-04-01
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  7. 2021-04-08
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  8. 2021-04-15
    Survey response — day 42, dose 2
    MedDRA: Arthralgia, Haematoma, Joint noise, Musculoskeletal stiffness, Myalgia, Office visit, Pre-existing disease, Tenodesis — Feeling: Fair · Get care from a doctor or other healthcare professional
    Free text: Symptoms: I developed la hematoma in my left bicep. The doctor injected me in back of shoulder. I had torn labrum surgery 4 yrs ago n now have shoulder stiffness with cracklings n stiffness n pain in bicep. · Healthcare visit (other): Went to GP n scheduling appointment with Orthopaedic surgeon
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-04-15
    Report sent to call center — day 42, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  10. 2021-06-03
    Health check-in — 3 months, dose 2
    Feeling: Fair
    Adult check-in
  11. 2021-09-09
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  12. 2021-10-26
    Dose 3 — Moderna
  13. 2021-10-30
    Survey response — days 1–6 daily, dose 3
    MedDRA: Adverse reaction — Feeling: Good · Site: Pain · Chills · Be unable to do your normal daily activities
    Free text: I had these symptoms 10/27/2021. I am fine today 12/30
    MedDRA releases: 2024-11 · check-in free text available
  14. 2021-11-04
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  15. 2021-11-11
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  16. 2021-11-18
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  17. 2022-02-23
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

DoseDateManufacturerCo-administered
12021-01-22Moderna
22021-03-04Moderna
32021-10-26Moderna No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 6 — day 14, dose 2

2021-03-20

Symptoms: When the vaccine was administered, I bled some. Had some reactions the next day (arm soreness, lightheaded) but was good the following day. Then a week later redness, stingy, and then a brown yellowish tint and now a greenish tint. It is improving

Release 7 — day 42, dose 2

2021-04-15

Symptoms: I developed la hematoma in my left bicep. The doctor injected me in back of shoulder. I had torn labrum surgery 4 yrs ago n now have shoulder stiffness with cracklings n stiffness n pain in bicep.
Healthcare visit (other): Went to GP n scheduling appointment with Orthopaedic surgeon

Release 10 — days 1–6 daily, dose 3

2021-10-30

Systemic reaction (other): I had these symptoms 10/27/2021. I am fine today 12/30

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

FieldPreferred term2021-092023-042024-11
HCVOOffice visit ✓ ✓ ✓
SDArthralgia ○ ✓ ○
SDDizziness ✓ ✓ ✓
SDHaematoma ✓ ✓ ✓
SDInjection site discolouration ✓ ✓ ✓
SDInjection site erythema ✓ ✓ ✓
SDInjection site haemorrhage ✓ ✓ ✓
SDInjection site pain ✓ ✓ ✓
SDJoint noise ✓ ✓ ✓
SDMusculoskeletal stiffness ✓ ✓ ✓
SDMyalgia ✓ · ✓
SDOffice visit · · ✓
SDPre-existing disease ✓ · ✓
SDTenodesis ○ ✓ ○
SROAdverse reaction · · ✓

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

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