28P-13031-21643

1 vaccination 6 coded responses 12 check-ins 6 free-text entries 7 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 596 / MT
Registered: 2020-12-30

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

2020-12-30
Registered in v-safe
2020-12-30
Dose 1 — Moderna
2020-12-30
Survey response — day 0, dose 1
MedDRA: Adverse reaction, Pre-existing disease — Feeling: Fair · Site: Pain, Itching · Chills, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Shellfish allergy seems to have made reaction worse

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-30
Report sent to call center — day 0, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-01
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Itching · Chills, Headache, Joint pains, 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

Adult check-in
2021-01-01
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain, Itching · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-01-02
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-05
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Rash, not including the immediate area around the injection site

Adult check-in
2021-01-06
Health check-in — day 7, dose 1
Feeling: Fair · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-01-13
Survey response — day 14, dose 1
MedDRA: Office visit, Urticaria — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Excessive facial hives, requiring further meds · Healthcare visit (other): On site facility, medical clinic

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-20
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-29
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-02-03
Survey response — day 35, dose 1
MedDRA: Rash — Feeling: Fair

Free text: Rashes, multiple rashes. It has been 5 weeks + days. I am still having rashes. No change in env, soaps/dtrgnts, food types/brands. No i've not received further medical care they have done all that they know.This is either cont' reaction or further

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — day 42, dose 1
MedDRA: Dermatitis allergic — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Allergic rash. Continued since 12/30

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Report sent to call center — day 42, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-30
Survey response — 6 months, dose 1
MedDRA: Immunisation reaction — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Extreme allergic reactions. Ongoing 6 months

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-30
Report sent to call center — 6 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-02
Call 1 — Left Voicemail
2021-12-30
Survey response — 12 months, dose 1
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Exacerbated asthma issues with continuous use of Antihistamines and rescue inhaler

MedDRA releases: 2024-11 · check-in free text available
2021-12-30
Report sent to call center — 12 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-03
Call 1 — Could Not Reach Participant
2022-01-06
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-30	Moderna

Call center

7 call center cases

5 successful · 2 unsuccessful

See the call center timeline

Free text

Release 1 — day 0, dose 1

2020-12-30

Systemic reaction (other): Shellfish allergy seems to have made reaction worse

Release 1 — day 14, dose 1

2021-01-13

Symptoms: Excessive facial hives, requiring further meds

Healthcare visit (other): On site facility, medical clinic

Release 3 — day 35, dose 1

2021-02-03

Symptoms: Rashes, multiple rashes. It has been 5 weeks + days. I am still having rashes. No change in env, soaps/dtrgnts, food types/brands. No i've not received further medical care they have done all that they know.This is either cont' reaction or further

Release 4 — day 42, dose 1

2021-02-10

Symptoms: Allergic rash. Continued since 12/30

Release 9 — 6 months, dose 1

2021-06-30

Symptoms: Extreme allergic reactions. Ongoing 6 months

Release 10 — 12 months, dose 1

2021-12-30

Symptoms: Exacerbated asthma issues with continuous use of Antihistamines and rescue inhaler

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	Asthma	·	·	✓
SD	Dermatitis allergic	✓	✓	✓
SD	Immunisation reaction	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Rash	✓	✓	✓
SD	Urticaria	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Food allergy	○	○	○
SRO	Pre-existing disease	✓	✓	✓

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