3SR-22668-73170

4 vaccinations 5 coded responses 15 check-ins 4 free-text entries 4 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 295 / SC
Registered: 2022-11-02

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

Possible VAERS report

VAERS ID	Confidence	Score	Runner-up	Shared symptoms	Dose	State	VAERS vaccinated / onset / received	Call case
2497901 (opens in a new window)	high	11 / 11	—	5 of 8 VAERS symptoms	same dose (4)	SC matches	2022-11-02 / 2022-11-02 / 2022-11-03 received 35 days before the last call	case 1208422

From the VAERS matching of call center cases (loader/vaers_match_*). Only the best match is shown, and only if it scores 8 or more out of 11. The score adds up timing (VAERS received soon after the call center contact), dose and shared symptoms; state only breaks ties. Confidence is high when the score is 8+ and at least 3 points ahead of the runner-up, medium when 5+ and 2 ahead, otherwise low. A match is a likely link, not a confirmed one.

Timeline

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

2021-03-04
Dose 1 — Moderna
2021-04-01
Dose 2 — Moderna
2021-10-28
Dose 3 — Moderna
2022-11-02
Registered in v-safe
2022-11-02
Dose 4 — Moderna
2022-11-02
Survey response — day 0, dose 4
MedDRA: Emergency care, Eye swelling, Hypotension, Immediate post-injection reaction, Pharyngeal swelling, Pruritus, Urticaria — Feeling: Good · Site: Itching · Diarrhea · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Systemic reaction (other): Severe hives on forearms, neck and very itchy scalp. Swelling of eyes and throat. Severe Hypotension with BP in the 40's . 911 called ? ambulance to ER · Healthcare visit (other): Rushed to the ER via ambulance after I returned to CVS 2 minutes away from where I was. Vaccine at 11:10 am with onset of first symptoms of itching and hives 30 minutes after vaccine administration

MedDRA releases: 2024-11 · check-in free text available
2022-11-02
Report sent to call center — day 0, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-11-03
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-11-03
Call 1 — Left Voicemail
2022-11-03
Call successful
Completed over the phone
2022-11-04
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-11-05
Survey response — days 1–6 daily, dose 4
MedDRA: Arthralgia — Feeling: Good · Site: Itching · Muscle or body aches

Free text: Right shoulder pain

MedDRA releases: 2024-11 · check-in free text available
2022-11-06
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-11-07
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-11-08
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-11-09
Survey response — day 7, dose 4
MedDRA: Emergency care, Erythema, Urticaria — Feeling: Poor · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Systemic reaction (other): Broke out in hives on both forearms and Abdomen.Had to go to the ER again · Healthcare visit (other): Severe Hives on abdomen and forearms. Red neck

MedDRA releases: 2024-11 · check-in free text available
2022-11-09
Report sent to call center — day 7, dose 4
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-11-10
Call 1 — Left Voicemail
2022-11-10
Call successful
Completed over the phone
2022-11-16
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-23
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-30
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-12-07
Survey response — day 35, dose 4
MedDRA: Condition aggravated, Hypoaesthesia, Paraesthesia, Pre-existing disease, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Experiencing worsening Nerve damage symptoms of tingling and numbness in right arm to shoulder · Healthcare visit (other): Scheduled a visit to the pain and neurology center at earliest appointment available in January

MedDRA releases: 2024-11 · check-in free text available
2022-12-07
Report sent to call center — day 35, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-12-08
Call 1 — Left Voicemail
2022-12-08
Call successful
Reported to VAERS during previous contact from GDIT
2022-12-14
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2023-02-01
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2023-05-03
Survey response — 6 months, dose 4
MedDRA: Office visit, Rash, Urticaria, Urticaria chronic — Feeling: Good · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-05-03
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2023-05-04
Call 1 — Could Not Reach Participant
2023-05-12
Call 2 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-04	Moderna	No
2	2021-04-01	Moderna	No
3	2021-10-28	Moderna	No
4	2022-11-02	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

VAERS report filed, before or during a call: 3

See the call center timeline

Free text

Release 12 — day 0, dose 4

2022-11-02

Systemic reaction (other): Severe hives on forearms, neck and very itchy scalp. Swelling of eyes and throat. Severe Hypotension with BP in the 40's . 911 called ? ambulance to ER

Healthcare visit (other): Rushed to the ER via ambulance after I returned to CVS 2 minutes away from where I was. Vaccine at 11:10 am with onset of first symptoms of itching and hives 30 minutes after vaccine administration

Release 12 — days 1–6 daily, dose 4

2022-11-05

Systemic reaction (other): Right shoulder pain

Release 12 — day 7, dose 4

2022-11-09

Systemic reaction (other): Broke out in hives on both forearms and Abdomen.Had to go to the ER again

Healthcare visit (other): Severe Hives on abdomen and forearms. Red neck

Release 12 — day 35, dose 4

2022-12-07

Symptoms: Experiencing worsening Nerve damage symptoms of tingling and numbness in right arm to shoulder

Healthcare visit (other): Scheduled a visit to the pain and neurology center at earliest appointment available in January

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	Emergency care	·	·	✓
HCVO	Erythema	·	·	✓
HCVO	Immediate post-injection reaction	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Pruritus	·	·	✓
HCVO	Unevaluable event	·	·	✓
HCVO	Urticaria	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Office visit	·	·	✓
SD	Paraesthesia	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Rash	·	·	✓
SD	Urticaria	·	·	✓
SD	Urticaria chronic	·	·	✓
SRO	Arthralgia	·	·	✓
SRO	Emergency care	·	·	✓
SRO	Eye swelling	·	·	✓
SRO	Hypotension	·	·	✓
SRO	Pharyngeal swelling	·	·	✓
SRO	Pruritus	·	·	✓
SRO	Urticaria	·	·	✓

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