3MZ-10219-83750

3 vaccinations 13 coded responses 31 check-ins 13 free-text entries 1 call case

Sex: Female
Age at first dose: 51-55
ZIP prefix: 958 / CA
Registered: 2021-03-18

Relationship: Self
Race: Asian
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-03-17
Dose 1 — Moderna
2021-03-18
Registered in v-safe
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Immediate post-injection reaction, Insomnia, Pharyngeal paraesthesia, Pruritus, Rash, Tongue pruritus — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site

Free text: Allergic to iodinated dyes and gadolinium and to food like pineapple, lobster & cinnamon. After 15 mins. of vaccination felt a tingling feeling in the throat and mild tongue itching. After 2 hrs of vaccination, started with itching of face and arms and had strange rash on both lower arms - a red streaked line which disappeared in 10 to 15 mins. And within 4 hours got generalized itching on body -face, scalp, ears,eyes, legs, arms and body. Also had a feeling of something stuck in the throat. Was up all night due to the itching! By morning around 6 am it subsided. Had the shot around 7.45 pm previous night

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Itching · Fever · Chills, Nausea

Adult check-in
2021-03-21
Survey response — days 1–6 daily, dose 1
MedDRA: Paraesthesia — Feeling: Good · Fever · Nausea

Free text: Pins and needles today and yesterday (forgot to mention it yesterday)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Paraesthesia — Feeling: Fair · Fever · Chills

Free text: Tired, pins and needles

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-24
Health check-in — day 7, dose 1
Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-02
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-08
Survey response — day 21, dose 1
MedDRA: Chills, Eye pruritus, Oropharyngeal pain, Piloerection, Pyrexia, Sneezing — Feeling: Fair

Free text: Feverish, goose bumps/ chills, sore throat , itchy eyes and sneezing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-22
Dose 2 — Moderna
2021-04-22
Health check-in — day 35, dose 1
Feeling: Good

Adult check-in
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus, Throat irritation, Tongue pruritus — Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Itching of face, scalp, ear lobes, tongue and throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea — Feeling: Fair · Site: Pain, Itching · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Shortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Survey response — days 1–6 daily, dose 2
MedDRA: Nasopharyngitis, Sneezing — Feeling: Fair · Site: Pain, Itching · Nausea

Free text: Sneezing and cold like symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite — Feeling: Fair · Headache, Fatigue or tiredness

Free text: loss of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Survey response — days 1–6 daily, dose 2
MedDRA: Nasopharyngitis, Rhinorrhoea — Feeling: Fair · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Runny nose , cold like symptoms,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-05-06
Survey response — day 14, dose 2
MedDRA: Dyspnoea, Haemoptysis, Pulmonary pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Shortness of breath, lung pain in the back and bloody sputum

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Survey response — day 21, dose 2
MedDRA: Dyspnoea, Haemoptysis, Pulmonary pain — 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

Free text: Shortness of breath, lung pain, bloody sputum

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-24
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-27
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-03
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-02-26
Dose 3 — Moderna
2022-03-03
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Itching · Fever · Chills, Headache, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2022-03-06
Survey response — day 7, dose 3
MedDRA: Pruritus — Feeling: Fair · Site: Itching · Fever · Headache, Muscle or body aches

Free text: Itching

MedDRA releases: 2024-11 · check-in free text available
2022-03-13
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-03-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-03-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-04-02
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-05-11
Call successful
Participant prefers to complete VAERS report online
2022-05-30
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-08-28
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-17	Moderna
2	2021-04-22	Moderna
3	2022-02-26	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-18

Systemic reaction (other): Allergic to iodinated dyes and gadolinium and to food like pineapple, lobster & cinnamon. After 15 mins. of vaccination felt a tingling feeling in the throat and mild tongue itching. After 2 hrs of vaccination, started with itching of face and arms and had strange rash on both lower arms - a red streaked line which disappeared in 10 to 15 mins. And within 4 hours got generalized itching on body -face, scalp, ears,eyes, legs, arms and body. Also had a feeling of something stuck in the throat. Was up all night due to the itching! By morning around 6 am it subsided. Had the shot around 7.45 pm previous night

Release 6 — days 1–6 daily, dose 1

2021-03-21

Systemic reaction (other): Pins and needles today and yesterday (forgot to mention it yesterday)

2021-03-22

Systemic reaction (other): Tired, pins and needles

Release 7 — day 21, dose 1

2021-04-08

Symptoms: Feverish, goose bumps/ chills, sore throat , itchy eyes and sneezing

Release 7 — days 1–6 daily, dose 2

2021-04-23

Systemic reaction (other): Itching of face, scalp, ear lobes, tongue and throat

2021-04-24

Systemic reaction (other): Shortness of breath

2021-04-25

Systemic reaction (other): Sneezing and cold like symptoms

Release 8 — days 1–6 daily, dose 2

2021-04-26

Systemic reaction (other): loss of appetite

2021-04-27

Systemic reaction (other): Runny nose , cold like symptoms,

2021-04-28

Systemic reaction (other): Itching

Release 8 — day 14, dose 2

2021-05-06

Symptoms: Shortness of breath, lung pain in the back and bloody sputum

Release 8 — day 21, dose 2

2021-05-14

Symptoms: Shortness of breath, lung pain, bloody sputum

Release 11 — day 7, dose 3

2022-03-06

Systemic reaction (other): Itching

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	Chills	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Eye pruritus	✓	✓	✓
SD	Haemoptysis	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Piloerection	✓	✓	✓
SD	Pulmonary pain	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Sneezing	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Nasopharyngitis	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Pharyngeal paraesthesia	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sneezing	✓	✓	✓
SRO	Throat irritation	✓	✓	✓
SRO	Tongue pruritus	✓	✓	✓

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