ZY6-69628-26188

2 vaccinations 7 coded responses 13 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 337 / FL
Registered: 2021-02-20

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

2021-01-20
Dose 1 — Moderna
2021-02-17
Dose 2 — Moderna
2021-02-20
Registered in v-safe
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Fatigue, Hypersomnia, Injection site induration, Injection site mass, Injection site nodule, Injection site reaction — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Free text: Injection site reactions happened on both the first and worst on the second. Fatigue on the second shot started about 10 hours after the shot and I slept for approximately 36 hours with no appetite. No fever. After the first shot, Only injection site reaction nine days after lasting for two weeks turning into a hard knot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Survey response — days 1–6 daily, dose 2
MedDRA: Oral herpes — Feeling: Fair · Site: Redness, Swelling, Itching

Free text: Cold sore coming from nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · None

Adult check-in
2021-02-24
Health check-in — day 7, dose 2
Feeling: Good · None

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

Adult check-in
2021-03-10
Survey response — day 21, dose 2
MedDRA: Fatigue — Feeling: Good

Free text: Ongoing fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — day 28, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: More fatigue and exhaustion. No fever, chills, or anything of that sort, just extremely fatigued. Cant even swing a golf club which is new starting Sunday. Can still function, just exhausted. Last reaction from first shot occ 9days later

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Survey response — day 35, dose 2
MedDRA: Erythema, Feeling hot, Muscle disorder, Myositis, Office visit, Peripheral swelling — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: The reaction that occurred after my first vaccination in my left arm which was done with a very large needle and Became swollen, hot, red, for several days, deteriorated my bicep tendon from inflammation and Disconnected from anchor. The doctor yeste · Healthcare visit (other): Orthopedic physician

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-02
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-19
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-18
Survey response — 6 months, dose 2
MedDRA: Injection site pain, Injection site reaction, Muscle rupture, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: The torn biceps from where the shot was given its very painful. I might have to have surgery. · Healthcare visit (other): Orthopedic surgeon

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-18
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-19
Call successful
Participant prefers to complete VAERS report online
2022-02-17
Survey response — 12 months, dose 2
MedDRA: Office visit, Surgery, Tendon operation, Tendon rupture — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: After I had the initial tear of my bicep tendon several days after the first injection, the tendon tore all the way. Just had surgery the end of January to Reattach the bicep tendon. Still recovering, and in a sling. Recovery minimum 4 to 5 months. · Healthcare visit (other): Outpatient surgery at hospital

MedDRA releases: 2024-11 · check-in free text available
2022-02-17
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-02-18
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-20	Moderna
2	2021-02-17	Moderna

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-20

Systemic reaction (other): Injection site reactions happened on both the first and worst on the second. Fatigue on the second shot started about 10 hours after the shot and I slept for approximately 36 hours with no appetite. No fever. After the first shot, Only injection site reaction nine days after lasting for two weeks turning into a hard knot

2021-02-21

Systemic reaction (other): Cold sore coming from nose

Release 5 — day 21, dose 2

2021-03-10

Symptoms: Ongoing fatigue

Release 5 — day 28, dose 2

2021-03-17

Symptoms: More fatigue and exhaustion. No fever, chills, or anything of that sort, just extremely fatigued. Cant even swing a golf club which is new starting Sunday. Can still function, just exhausted. Last reaction from first shot occ 9days later

Release 6 — day 35, dose 2

2021-03-24

Symptoms: The reaction that occurred after my first vaccination in my left arm which was done with a very large needle and Became swollen, hot, red, for several days, deteriorated my bicep tendon from inflammation and Disconnected from anchor. The doctor yeste cut off by CDC

Healthcare visit (other): Orthopedic physician

Release 9 — 6 months, dose 2

2021-08-18

Symptoms: The torn biceps from where the shot was given its very painful. I might have to have surgery.

Healthcare visit (other): Orthopedic surgeon

Release 11 — 12 months, dose 2

2022-02-17

Symptoms: After I had the initial tear of my bicep tendon several days after the first injection, the tendon tore all the way. Just had surgery the end of January to Reattach the bicep tendon. Still recovering, and in a sling. Recovery minimum 4 to 5 months. cut off by CDC

Healthcare visit (other): Outpatient surgery at hospital

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	Surgery	·	·	✓
SD	Erythema	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling hot	✓	✓	✓
SD	Injection site pain	✓	·	✓
SD	Injection site reaction	✓	·	✓
SD	Muscle disorder	✓	✓	✓
SD	Muscle rupture	✓	·	✓
SD	Myositis	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Tendon operation	·	·	✓
SD	Tendon rupture	·	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Hypersomnia	✓	✓	✓
SRO	Injection site induration	✓	·	✓
SRO	Injection site mass	○	✓	○
SRO	Injection site nodule	✓	·	✓
SRO	Injection site reaction	✓	✓	✓
SRO	Oral herpes	✓	✓	✓

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