4JB-73871-03636 · OpenVSafe

Timeline

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

2021-03-25
Dose 1 — Moderna
2021-03-29
Registered in v-safe
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-10
Survey response — day 14, dose 1
MedDRA: Pre-existing disease, Pruritus, Rash — Feeling: Fair

Free text: Allergy symptoms, itchy skin, skin breakouts all over.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Dose 2 — Moderna
2021-06-24
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-12-15
Dose 3 — Moderna
2022-03-27
Survey response — 12 months, dose 1
MedDRA: COVID-19, Periarthritis — 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: I had covid a month after getting my booster shot. Also I have suffered from frozen shoulder as result from where I received vaccine from the second shot.

MedDRA releases: 2024-11 · check-in free text available
2022-03-27
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)
2022-03-29
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-25	Moderna
2	2021-05-19	Moderna	No
3	2021-12-15	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-03-27	Unsuccessful

Free text

Release 7 — day 14, dose 1

2021-04-10

Symptoms: Allergy symptoms, itchy skin, skin breakouts all over.

Release 11 — 12 months, dose 1

2022-03-27

Symptoms: I had covid a month after getting my booster shot. Also I have suffered from frozen shoulder as result from where I received vaccine from the second shot.

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	COVID-19	·	·	✓
SD	Periarthritis	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓

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