64G-77126-65057

4 vaccinations 12 coded responses 42 check-ins 12 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 950 / CA
Registered: 2021-03-09

Relationship: Self
Race: American Indian or Alaska Native
Ethnicity: Hispanic or Latino

Timeline

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

2021-02-09
Dose 1 — Moderna
2021-03-09
Registered in v-safe
2021-03-09
Dose 2 — Moderna
2021-03-09
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Good

Free text: Nothing yet

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-03-13
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain — Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: The left arm where it was injected. A still a little sore but less each day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Limb discomfort, Pain in extremity — Feeling: Good · Site: Pain

Free text: Arm still continues to ache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-06
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-13
Survey response — day 35, dose 2
MedDRA: Nodule, Pain, Pain in extremity — Feeling: Good

Free text: The left arm / outside the bicep muscle continues to hurt - theres a knot in the muscle. It also hurts when lifting the arm above my shoulder. It started after the second shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Survey response — day 42, dose 2
MedDRA: Myalgia, Pain in extremity — Feeling: Good

Free text: The left arm outer bicep still hurts - the muscle continues to heal slowly.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-08
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-09-07
Survey response — 6 months, dose 2
MedDRA: Injected limb mobility decreased, Injection site pain, Office visit, Pain — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Still have the ache in the left arm where the injection was placed. I can lift the arm upward & a little higher but still have some pain. · Healthcare visit (other): Normal doctors visit A I forgot to mention the pain to the doctor.

MedDRA releases: 2024-11 · check-in free text available
2021-09-07
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-14
Call 1 — Left Voicemail
2021-09-14
Call successful
Completed over the phone
2021-10-25
Dose 3 — Moderna
2021-10-25
Health check-in — day 0, dose 3
Feeling: Good · Headache

Adult check-in
2021-10-26
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness, Headache — Feeling: Fair · Headache

Free text: Little dizzy this morning - dull headache

MedDRA releases: 2024-11 · check-in free text available
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache

Adult check-in
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness — Feeling: Good · Headache, Fatigue or tiredness

Free text: Little dizzy

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache

Adult check-in
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue — Feeling: Good · Headache

Free text: Feel tired

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue — Feeling: Good · Headache

Free text: Tired

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Survey response — day 7, dose 3
MedDRA: Fatigue — Feeling: Good · Headache

Free text: Less tired today

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-15
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-22
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-29
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-06
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-24
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-12
Dose 4 — Moderna
2022-05-14
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-05-16
Survey response — days 1–6 daily, dose 4
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-19
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-26
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-02
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-09
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-16
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-23
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-11
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-10
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-12
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Moderna
2	2021-03-09	Moderna
3	2021-10-25	Moderna	No
4	2022-05-12	Moderna	No

Call center

1 call center case

1 successful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 5 — day 0, dose 2

2021-03-09

Systemic reaction (other): Nothing yet

Release 5 — days 1–6 daily, dose 2

2021-03-13

Systemic reaction (other): The left arm where it was injected. A still a little sore but less each day.

2021-03-15

Systemic reaction (other): Arm still continues to ache

Release 7 — day 35, dose 2

2021-04-13

Symptoms: The left arm / outside the bicep muscle continues to hurt - theres a knot in the muscle. It also hurts when lifting the arm above my shoulder. It started after the second shot.

Release 7 — day 42, dose 2

2021-04-20

Symptoms: The left arm outer bicep still hurts - the muscle continues to heal slowly.

Release 9 — 6 months, dose 2

2021-09-07

Symptoms: Still have the ache in the left arm where the injection was placed. I can lift the arm upward & a little higher but still have some pain.

Healthcare visit (other): Normal doctors visit A I forgot to mention the pain to the doctor.

Release 10 — days 1–6 daily, dose 3

2021-10-26

Systemic reaction (other): Little dizzy this morning - dull headache

2021-10-28

Systemic reaction (other): Little dizzy

2021-10-30

Systemic reaction (other): Feel tired

2021-10-31

Systemic reaction (other): Tired

Release 10 — day 7, dose 3

2021-11-01

Systemic reaction (other): Less tired today

Release 11 — days 1–6 daily, dose 4

2022-05-16

Systemic reaction (other): No

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	Pain	·	·	✓
SD	Injected limb mobility decreased	·	·	✓
SD	Injection site pain	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Nodule	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SRO	Dizziness	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Headache	·	·	✓
SRO	Injection site pain	✓	✓	✓
SRO	Limb discomfort	✓	✓	○
SRO	No adverse event	✓	✓	✓
SRO	Pain in extremity	·	·	✓

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