36Z-20407-67733
4 vaccinations
4 coded responses
41 check-ins
4 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 988 / WA
- Registered
- 2021-02-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-04
Registered in v-safe
-
2021-02-04
Dose 1 — Moderna
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-11
- 2021-02-18
- 2021-02-25
-
2021-03-04
Dose 2 — Moderna
- 2021-03-04
-
2021-03-05
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Chills, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-18
- 2021-03-25
- 2021-04-01
- 2021-04-08
- 2021-04-15
-
2021-06-03
Survey response — 3 months, dose 2MedDRA: Office visit, Psoriasis, Rash — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: 3 days after last Moderna shot had spot on my left side. Thought it was spider bite. Skin spots exploded 2 weeks later and have been dealing with it all over torso. Finally diagnosed May 4 as plaque psoriasis probably brought on from vaccine. · Healthcare visit (other): Regular doctor appointmentsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-06-03
Report sent to call center — 3 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-09-02
Survey response — 6 months, dose 2MedDRA: Acute febrile neutrophilic dermatosis, Office visit, Psoriasis, Skin disorder — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Had a major skin disorder that in May was diagnosed as plaque psoriasis. Saw rheumatology last month and they diagnosed it as Sweets Syndrome. Told me not to get booster. · Healthcare visit (other): Appointment w/clinicMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-09-02
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-08
-
2021-09-09
Call successfulCompleted over the phone
-
2022-02-08
Dose 3 — Pfizer-BioNTech
- 2022-03-04
- 2022-05-10
-
2022-08-06
Dose 4 — Pfizer-BioNTech
-
2022-08-07
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain, Redness, Swelling · NoneAdult check-in
-
2022-08-08
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Redness, Swelling · NoneAdult check-in
-
2022-08-09
Survey response — days 1–6 daily, dose 4MedDRA: Dizziness, Nausea — Feeling: Good · Site: RednessFree text: Had a bad spell of dizziness at bedtime, continuing as I fell asleep, bringing on nausea. Felt fine upon awakening.MedDRA releases: 2024-11 · check-in free text available
- 2022-08-10
- 2022-08-11
- 2022-08-12
- 2022-08-13
- 2022-08-20
- 2022-08-28
-
2022-09-03
Survey response — day 28, dose 4MedDRA: Unevaluable event — Feeling: GoodFree text: Poison ivyMedDRA releases: 2024-11 · check-in free text available
- 2022-09-10
- 2022-09-17
- 2022-11-05
- 2023-02-04
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-04 | Moderna | |
| 2 | 2021-03-04 | Moderna | |
| 3 | 2022-02-08 | Pfizer-BioNTech | No |
| 4 | 2022-08-06 | Pfizer-BioNTech | No |
Call center
2 call center cases
2 successful
VAERS report filed, before or during a call: 2
Free text
Release 8 — 3 months, dose 2
Symptoms: 3 days after last Moderna shot had spot on my left side. Thought it was spider bite. Skin spots exploded 2 weeks later and have been dealing with it all over torso. Finally diagnosed May 4 as plaque psoriasis probably brought on from vaccine.
Healthcare visit (other): Regular doctor appointments
Release 9 — 6 months, dose 2
Symptoms: Had a major skin disorder that in May was diagnosed as plaque psoriasis. Saw rheumatology last month and they diagnosed it as Sweets Syndrome. Told me not to get booster.
Healthcare visit (other): Appointment w/clinic
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): Had a bad spell of dizziness at bedtime, continuing as I fell asleep, bringing on nausea. Felt fine upon awakening.
Release 12 — day 28, dose 4
Symptoms: Poison ivy
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 | Acute febrile neutrophilic dermatosis | ✓ | · | ✓ |
| SD | Office visit | ✓ | · | ✓ |
| SD | Psoriasis | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SD | Skin disorder | ✓ | · | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SRO | Dizziness | · | · | ✓ |
| SRO | Nausea | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release