23G-43242-16269

2 vaccinations 8 coded responses 15 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 317 / GA
Registered: 2021-03-28

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

2021-03-03
Dose 1 — Moderna
2021-03-28
Registered in v-safe
2021-03-28
Survey response — day 21, dose 1
MedDRA: Anaphylactic reaction, Depression, Immediate post-injection reaction, Pain, Pain in extremity, Pruritus, Rash, Rash macular — Feeling: Good

Free text: Suffered anaphalatic shock 4.5 mins after shot. Developed red splotchy rash on neck, shot arm super sore 2.5 weeks, then stang like a bee sting & itched, sever depression starting 2 days afterwards lasting 5 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Dose 2 — Moderna
2021-04-01
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Muscle spasms — Feeling: Fair · Site: Redness · Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site

Free text: Lower back ache & legs trying to throw crampsp

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Muscle spasms — Feeling: Fair · Site: Pain, Redness · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Leg cramps

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — days 1–6 daily, dose 2
MedDRA: Rash — Feeling: Good · Site: Redness · Rash, not including the immediate area around the injection site

Free text: Neck rash almost gone..down to a faint pink

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Survey response — days 1–6 daily, dose 2
MedDRA: Musculoskeletal discomfort, Pruritus — Feeling: Good · Site: Redness · Rash, not including the immediate area around the injection site

Free text: Neck is still mildly punk but quite itchy today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Tenderness — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Neck area still slightly pink & tender.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — day 7, dose 2
MedDRA: Depression — Feeling: Fair · Site: Redness · Rash, not including the immediate area around the injection site

Free text: Depression hit again

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-21
Health check-in — day 21, dose 2
Feeling: Good

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

Adult check-in
2021-05-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-12
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-29
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-03-31
Survey response — 12 months, dose 2
MedDRA: Office visit, Polymyalgia rheumatica, Reaction to previous exposure to any vaccine — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: In process of being diagnosed with Polymyalgia rheumatica. Symptoms began developing in late but thought due to a back injury. It was NOT. Had a BAD reaction to shots 1 & 2. Refuse to take booster. · Healthcare visit (other): Went to 3 doctors ofc since & husband figured it out. I was being ignored based on my appearance & told it was in my head.

MedDRA releases: 2024-11 · check-in free text available
2022-03-31
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2022-04-05
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-03	Moderna
2	2021-03-31	Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 6 — day 21, dose 1

2021-03-28

Symptoms: Suffered anaphalatic shock 4.5 mins after shot. Developed red splotchy rash on neck, shot arm super sore 2.5 weeks, then stang like a bee sting & itched, sever depression starting 2 days afterwards lasting 5 days

Release 6 — days 1–6 daily, dose 2

2021-04-01

Systemic reaction (other): Lower back ache & legs trying to throw crampsp

2021-04-02

Systemic reaction (other): Leg cramps

2021-04-03

Systemic reaction (other): Neck rash almost gone..down to a faint pink

2021-04-04

Systemic reaction (other): Neck is still mildly punk but quite itchy today

2021-04-05

Systemic reaction (other): Neck area still slightly pink & tender.

Release 7 — day 7, dose 2

2021-04-07

Systemic reaction (other): Depression hit again

Release 11 — 12 months, dose 2

2022-03-31

Symptoms: In process of being diagnosed with Polymyalgia rheumatica. Symptoms began developing in late but thought due to a back injury. It was NOT. Had a BAD reaction to shots 1 & 2. Refuse to take booster.

Healthcare visit (other): Went to 3 doctors ofc since & husband figured it out. I was being ignored based on my appearance & told it was in my head.

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	·	·	✓
SD	Anaphylactic reaction	✓	✓	✓
SD	Depression	✓	✓	✓
SD	Immediate post-injection reaction	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Polymyalgia rheumatica	·	·	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash macular	✓	✓	✓
SD	Reaction to previous exposure to any vaccine	·	·	✓
SRO	Back pain	✓	✓	✓
SRO	Depression	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓
SRO	Musculoskeletal discomfort	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Tenderness	✓	✓	✓

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