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YVB-21561-52301

3 vaccinations 8 coded responses 36 check-ins 8 free-text entries 2 call cases
Sex
Male
Age at first dose
56-60
ZIP prefix
782 / TX
Registered
2021-03-10
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-03-09
    Dose 1 — Moderna
  2. 2021-03-10
    Registered in v-safe
  3. 2021-03-10
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · None
    Adult check-in
  4. 2021-03-11
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · None
    Adult check-in
  5. 2021-03-12
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-03-13
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-03-14
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-03-15
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-03-16
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  10. 2021-03-23
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-03-30
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-04-06
    Dose 2 — Moderna
  13. 2021-04-06
    Survey response — day 0, dose 2
    MedDRA: Clavicle fracture — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: I broke a clavicle on Saturday, Apr 6.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-04-06
    Report sent to call center — day 0, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  15. 2021-04-07
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  16. 2021-04-08
    Survey response — days 1–6 daily, dose 2
    MedDRA: Pre-existing disease — Feeling: Good · Joint pains, Muscle or body aches · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Systemic reaction (other): My symptoms are most certainly due to my broken clavicle. · Healthcare visit (other): For the aforementioned broken clavicle.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-04-08
    Report sent to call center — days 1–6 daily, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  18. 2021-04-09
    Survey response — days 1–6 daily, dose 2
    MedDRA: Fracture pain — Feeling: Good · Muscle or body aches
    Free text: Still hurting from clavicular fracture.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-04-11
    Survey response — days 1–6 daily, dose 2
    MedDRA: Clavicle fracture — Feeling: Good · Joint pains
    Free text: Continuing clavicular fracture symptoms as mentioned previously
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  20. 2021-04-12
    Survey response — days 1–6 daily, dose 2
    MedDRA: Pain — Feeling: Good · Muscle or body aches
    Free text: Continue to have pain from clavicular fracture mentioned previously, surgery on Wednesday.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  21. 2021-04-15
    Survey response — day 7, dose 2
    MedDRA: Clavicle fracture, Surgery — Feeling: Poor · Joint pains, Muscle or body aches · Be unable to work
    Free text: Surgery for broken collarbone yesterday.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  22. 2021-04-20
    Survey response — day 14, dose 2
    MedDRA: Pain in extremity, Peripheral swelling — Feeling: Fair · Be unable to work
    Free text: Swollen, sore left arm.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  23. 2021-04-27
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-05-04
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-05-11
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-05-18
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-07-06
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  28. 2021-10-06
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  29. 2021-12-07
    Dose 3 — Pfizer-BioNTech
  30. 2021-12-10
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Itching · None
    Adult check-in
  31. 2021-12-11
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  32. 2021-12-12
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Joint pains
    Adult check-in
  33. 2021-12-13
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  34. 2021-12-14
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  35. 2021-12-21
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  36. 2021-12-29
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  37. 2022-01-04
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  38. 2022-01-11
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  39. 2022-01-18
    Survey response — day 42, dose 3
    MedDRA: Headache, Oropharyngeal pain — Feeling: Good
    Free text: Minor headaches, sore throat
    MedDRA releases: 2024-11 · check-in free text available
  40. 2022-02-02
  41. 2022-03-08
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  42. 2022-06-07
    Health check-in — 6 months, dose 3
    Feeling: Good
    Adult check-in
  43. 2022-12-07
    Health check-in — 12 months, dose 3
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-03-09Moderna
22021-04-06Moderna
32021-12-07Pfizer-BioNTech No

Call center

ReportedOutcomeVAERS-related outcome
2021-04-06 Unsuccessful
2021-04-08 Unsuccessful

Free text

Release 7 — day 0, dose 2

2021-04-06

Systemic reaction (other): I broke a clavicle on Saturday, Apr 6.

Release 7 — days 1–6 daily, dose 2

2021-04-08

Systemic reaction (other): My symptoms are most certainly due to my broken clavicle.
Healthcare visit (other): For the aforementioned broken clavicle.

2021-04-09

Systemic reaction (other): Still hurting from clavicular fracture.

2021-04-11

Systemic reaction (other): Continuing clavicular fracture symptoms as mentioned previously

2021-04-12

Systemic reaction (other): Continue to have pain from clavicular fracture mentioned previously, surgery on Wednesday.

Release 7 — day 7, dose 2

2021-04-15

Systemic reaction (other): Surgery for broken collarbone yesterday.

Release 7 — day 14, dose 2

2021-04-20

Symptoms: Swollen, sore left arm.

Release 10 — day 42, dose 3

2022-01-18

Symptoms: Minor headaches, sore throat

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
HCVOPre-existing disease ✓ ✓ ✓
SDHeadache · · ✓
SDOropharyngeal pain · · ✓
SDPain in extremity ✓ ✓ ✓
SDPeripheral swelling ✓ ✓ ✓
SROClavicle fracture ✓ ✓ ✓
SROFracture pain ✓ ✓ ✓
SROPain ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓
SROSurgery ✓ ✓ ✓

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

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