4BM-78116-98215
3 vaccinations
3 coded responses
24 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 430 / OH
- Registered
- 2021-01-02
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-01
Dose 1 — Moderna
-
2021-01-02
Registered in v-safe
- 2021-01-02
- 2021-01-03
- 2021-01-04
- 2021-01-06
- 2021-01-07
- 2021-01-08
- 2021-01-17
- 2021-01-22
-
2021-01-29
Dose 2 — Moderna
-
2021-01-30
Health check-in — days 1–6 daily, dose 2Feeling: Good · Muscle or body aches, Fatigue or tiredness, DiarrheaAdult check-in
- 2021-01-31
-
2021-02-01
Survey response — days 1–6 daily, dose 2MedDRA: Feeling abnormal, Pain in extremity — Feeling: Fair · Site: Pain · Fever · Muscle or body aches, DiarrheaFree text: I cant explain it, I just dont feel myself. There is a pain deeper inside my arm where I got the shot. That started last night.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-02
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue, Injection site erythema — Feeling: Fair · Site: Redness · Fatigue or tirednessFree text: My injection site became red, and gradually got redder as the day progressed, not hot or raised. This all occurred 3 days after my 2nd injection. Today the redness has faded, but Im still really tired. Tiredness began yesterday too.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-12
- 2021-02-19
- 2021-02-26
-
2021-04-12
Call successfulParticipant prefers to complete VAERS report online
-
2021-04-30
Survey response — 3 months, dose 2MedDRA: Local reaction, Office visit, Polymorphic light eruption — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: I visited Florida last week and came back with a horrible reaction on my legs only. I sought my dermatologist who diagnosed me with Polymorphic Light Eruption. Ive never had this occur prior to my vaccination, and I have been to FL multiple times · Healthcare visit (other): In office dermatology appointmentMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-30
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)
- 2021-07-30
-
2021-11-19
Dose 3 — ModernaCo-administered: Flu
- 2022-01-29
- 2022-02-18
- 2022-05-20
- 2022-11-19
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-01 | Moderna | |
| 2 | 2021-01-29 | Moderna | |
| 3 | 2021-11-19 | Moderna | Flu |
Call center
1 call center case
1 successful
Free text
Release 3 — days 1–6 daily, dose 2
Systemic reaction (other): I cant explain it, I just dont feel myself. There is a pain deeper inside my arm where I got the shot. That started last night.
Systemic reaction (other): My injection site became red, and gradually got redder as the day progressed, not hot or raised. This all occurred 3 days after my 2nd injection. Today the redness has faded, but Im still really tired. Tiredness began yesterday too.
Release 8 — 3 months, dose 2
Symptoms: I visited Florida last week and came back with a horrible reaction on my legs only. I sought my dermatologist who diagnosed me with Polymorphic Light Eruption. Ive never had this occur prior to my vaccination, and I have been to FL multiple times
Healthcare visit (other): In office dermatology appointment
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 | Local reaction | ✓ | ✓ | ✓ |
| SD | Polymorphic light eruption | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Feeling abnormal | ✓ | ✓ | ✓ |
| SRO | Injection site erythema | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release