4NH-24476-64665

4 vaccinations 5 coded responses 24 check-ins 5 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 983 / WA
Registered: 2021-03-04

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

Timeline

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

2021-01-27
Dose 1 — Moderna
2021-02-24
Dose 2 — Moderna
2021-03-04
Registered in v-safe
2021-03-04
Health check-in — day 7, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-03-10
Survey response — day 14, dose 2
MedDRA: Erythema, Injection site reaction, Pruritus, Rash, Rash erythematous, Self-medication — Feeling: Good

Free text: Day 10, very red rash shot(r) arm. 11) rash on both upper arms.day12- rash right arm and chest. Day 13) right arm itch face red , today red on bottom of face right side. Benadryl has been effective in keeping itching tolerable.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-31
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-25
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-23
Dose 3 — Moderna
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Muscle or body aches

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache

Adult check-in
2021-10-30
Health check-in — day 7, dose 3
Feeling: Good · Muscle or body aches

Adult check-in
2021-11-06
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-13
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-20
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-04
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-22
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-31
Dose 4 — Moderna
2022-04-23
Survey response — 6 months, dose 3
MedDRA: Rash, Rash pruritic, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Had my 2nd booster 3/31/22. fine until 5 days later. Got ITCHY rash, over my Torso, front&back. We flew to Kauai (2 weeks). Rash continued, actually worsened. blamed flying bugs and heat, Came home 4/18/22. Still have it. ITCHY! Seeing MD 4/26. · Healthcare visit (other): Made Dr appt. 4/26.

MedDRA releases: 2024-11 · check-in free text available
2022-04-23
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-27
Call 1 — Left Voicemail
2022-05-02
Survey response — day 28, dose 4
MedDRA: Rash, Rash pruritic — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Had my 2nd booster and 5 days later travelled to (b)(6). I broke out with an AWFUL ITCHY rash, started on my backs, by 4/5 it was randomly all over my body.

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-03
Call 1 — Left Voicemail
2022-05-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-03
Call successful
Participant prefers to complete VAERS report online
2022-05-05
Survey response — day 35, dose 4
MedDRA: Office visit, Rash pruritic — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I have been battling a BAD, ITCHY rash for 31 days. Dermatologist has given me a RX steroidal ointment to use 2x a day for 2 weeks. · Healthcare visit (other): I have seen a Dermatologist and my Primary Care DR.in their offices thos week.

MedDRA releases: 2024-11 · check-in free text available
2022-05-05
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)
2022-05-06
Call 1 — Left Voicemail
2022-05-06
Call successful
Participant prefers to complete VAERS report online
2022-05-12
Survey response — day 42, dose 4
MedDRA: Office visit, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Rash on my arm and back, torso · Healthcare visit (other): I went to Urgent care, My Primary Care DR. And My Dermatologist

MedDRA releases: 2024-11 · check-in free text available
2022-05-12
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-13
Call successful
Participant prefers to complete VAERS report online
2022-07-02
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-10-01
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-03-31
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-27	Moderna
2	2021-02-24	Moderna
3	2021-10-23	Moderna	No
4	2022-03-31	Moderna	No

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 5 — day 14, dose 2

2021-03-10

Symptoms: Day 10, very red rash shot(r) arm. 11) rash on both upper arms.day12- rash right arm and chest. Day 13) right arm itch face red , today red on bottom of face right side. Benadryl has been effective in keeping itching tolerable.

Release 11 — 6 months, dose 3

2022-04-23

Symptoms: Had my 2nd booster 3/31/22. fine until 5 days later. Got ITCHY rash, over my Torso, front&back. We flew to Kauai (2 weeks). Rash continued, actually worsened. blamed flying bugs and heat, Came home 4/18/22. Still have it. ITCHY! Seeing MD 4/26.

Healthcare visit (other): Made Dr appt. 4/26.

Release 11 — day 28, dose 4

2022-05-02

Symptoms: Had my 2nd booster and 5 days later travelled to (b)(6). I broke out with an AWFUL ITCHY rash, started on my backs, by 4/5 it was randomly all over my body.

redacted (b)(6)

Release 11 — day 35, dose 4

2022-05-05

Symptoms: I have been battling a BAD, ITCHY rash for 31 days. Dermatologist has given me a RX steroidal ointment to use 2x a day for 2 weeks.

Healthcare visit (other): I have seen a Dermatologist and my Primary Care DR.in their offices thos week.

Release 11 — day 42, dose 4

2022-05-12

Symptoms: Rash on my arm and back, torso

Healthcare visit (other): I went to Urgent care, My Primary Care DR. And My Dermatologist

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	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Erythema	✓	✓	✓
SD	Injection site reaction	✓	✓	✓
SD	Office visit	·	·	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash erythematous	✓	✓	✓
SD	Rash pruritic	·	·	✓
SD	Self-medication	✓	✓	✓

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