ZPC-67647-02605

3 vaccinations 7 coded responses 35 check-ins 7 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 070 / NJ
Registered: 2021-02-06

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

2021-02-05
Dose 1 — Moderna
2021-02-06
Registered in v-safe
2021-02-06
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Mobility decreased, Pain in extremity — Feeling: Poor · Site: Pain · Be unable to work, Be unable to do your normal daily activities

Free text: I cant move my arm. Pain from shoulder all the way down the arm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — days 1–6 daily, dose 1
MedDRA: Joint range of motion decreased — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities

Free text: I still dont have full range of motion with my arm yet.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Pain — Feeling: Good

Free text: Still some pain and limited movement in shoulder but less than yesterday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Good

Free text: Just mild pain in upper arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-05
Dose 2 — Moderna
2021-03-05
Survey response — day 0, dose 2
MedDRA: Feeling cold — Feeling: Good · Fatigue or tiredness

Free text: Cold but not chills

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain — Feeling: Good

Free text: Burning and tenderness at injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-04
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-24
Dose 3 — Moderna
Co-administered: Flu
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-31
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-07
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-14
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-21
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-28
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-05
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-23
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-27
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-24
Survey response — 12 months, dose 3
MedDRA: Atrial fibrillation, COVID-19, Hospitalisation, Myocarditis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Atrial fibrillation, myocarditis. Hospitalized on and off for 3 weeks. At the end of my stay in the hospital for those conditions, I caught COVID.

MedDRA releases: 2024-11 · check-in free text available
2022-10-24
Report sent to call center — 12 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-10-25
Call 1 — Could Not Reach Participant
2022-10-28
Call 2 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-05	Moderna
3	2021-10-24	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2022-10-24	Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-06

Systemic reaction (other): I cant move my arm. Pain from shoulder all the way down the arm.

2021-02-07

Systemic reaction (other): I still dont have full range of motion with my arm yet.

2021-02-08

Systemic reaction (other): Still some pain and limited movement in shoulder but less than yesterday.

2021-02-09

Systemic reaction (other): Just mild pain in upper arm

Release 5 — day 0, dose 2

2021-03-05

Systemic reaction (other): Cold but not chills

Release 5 — days 1–6 daily, dose 2

2021-03-07

Systemic reaction (other): Burning and tenderness at injection site

Release 12 — 12 months, dose 3

2022-10-24

Symptoms: Atrial fibrillation, myocarditis. Hospitalized on and off for 3 weeks. At the end of my stay in the hospital for those conditions, I caught COVID.

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
SD	Atrial fibrillation	·	·	✓
SD	COVID-19	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Myocarditis	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Feeling cold	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Joint range of motion decreased	✓	✓	✓
SRO	Mobility decreased	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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