Y93-15986-23437
3 vaccinations
5 coded responses
24 check-ins
5 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 140 / NY
- Registered
- 2021-01-22
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-21
Dose 1 — Moderna
-
2021-01-22
Registered in v-safe
- 2021-01-22
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-01-26
- 2021-01-27
- 2021-01-28
-
2021-02-04
Survey response — day 14, dose 1MedDRA: Pain in extremity — Feeling: GoodFree text: Sometimes vaccinated arm feels sore.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-13
-
2021-02-18
Dose 2 — Moderna
- 2021-02-18
-
2021-02-19
Survey response — days 1–6 daily, dose 2MedDRA: Poor quality sleep — Feeling: Good · Site: Pain · Fatigue or tirednessFree text: Didnt have a good nights sleep cause my husband experienced vaccine symptoms.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-21
- 2021-02-23
- 2021-02-24
- 2021-02-25
- 2021-03-04
- 2021-03-11
- 2021-03-19
- 2021-03-25
- 2021-04-01
-
2021-05-23
Survey response — 3 months, dose 2MedDRA: Injection site pain, Mobility decreased, Pain, Pain in extremity — Feeling: GoodFree text: My left upper arm, area of injection, sore when i use arm to make different moves.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-08-21
Survey response — 6 months, dose 2MedDRA: Office visit, Pain in extremity, Periarthritis, Physiotherapy — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Arm has been sore. Gradually more troublesome. Primary care dr prescribed physical therapy. PT said looks like frozen shoulder. Upcoming appt with an orthopedic dr for diagnosis verification. This all came on gradually after vaccine. · Healthcare visit (other): Primary dr appt,Physical therapy,MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-21
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-30
-
2021-11-02
Dose 3 — Moderna
-
2022-02-18
Survey response — 12 months, dose 2MedDRA: Periarthritis, Physiotherapy — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Diagnosed frozen left shoulder. This happens to be same arm I received my vaccines and boster. · Healthcare visit (other): Physical therapy, cortisone shotMedDRA releases: 2024-11 · check-in free text available
-
2022-02-18
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-02-21
- 2022-05-08
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-21 | Moderna | |
| 2 | 2021-02-18 | Moderna | |
| 3 | 2021-11-02 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-08-21 | Unsuccessful | |
| 2022-02-18 | Unsuccessful |
Free text
Release 3 — day 14, dose 1
Symptoms: Sometimes vaccinated arm feels sore.
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Didnt have a good nights sleep cause my husband experienced vaccine symptoms.
Release 8 — 3 months, dose 2
Symptoms: My left upper arm, area of injection, sore when i use arm to make different moves.
Release 9 — 6 months, dose 2
Symptoms: Arm has been sore. Gradually more troublesome. Primary care dr prescribed physical therapy. PT said looks like frozen shoulder. Upcoming appt with an orthopedic dr for diagnosis verification. This all came on gradually after vaccine.
Healthcare visit (other): Primary dr appt,Physical therapy,
Release 11 — 12 months, dose 2
Symptoms: Diagnosed frozen left shoulder. This happens to be same arm I received my vaccines and boster.
Healthcare visit (other): Physical therapy, cortisone shot
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 | ✓ | · | ✓ |
| SD | Injection site pain | ✓ | ✓ | ✓ |
| SD | Mobility decreased | ✓ | ✓ | ○ |
| SD | Office visit | ✓ | · | ✓ |
| SD | Pain | ✓ | ✓ | ✓ |
| SD | Pain in extremity | ✓ | ✓ | ✓ |
| SD | Periarthritis | ✓ | · | ✓ |
| SD | Physiotherapy | ✓ | · | ✓ |
| SRO | Poor quality sleep | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release