4W4-26002-55191

2 vaccinations 16 coded responses 26 check-ins 16 free-text entries 4 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 974 / OR
Registered: 2021-03-21

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

2021-03-21
Registered in v-safe
2021-03-21
Dose 1 — Moderna
2021-03-21
Survey response — day 0, dose 1
MedDRA: Injection site pain, Lip swelling, Oropharyngeal pain, Paraesthesia oral — Feeling: Fair · Site: Pain

Free text: I have had tingling lips which I am watching as I believe my lips have swollen a tiny bit. A sore throat started. Injection Site arm pain

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: Lip swelling — Feeling: Fair · Site: Pain · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Swollen lips still

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-23
Survey response — days 1–6 daily, dose 1
MedDRA: Hypersensitivity, Lip swelling — Feeling: Fair · Site: Pain

Free text: Swollen lips, diagnosed as mild allergic reaction

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Survey response — days 1–6 daily, dose 1
MedDRA: Immediate post-injection reaction, Lip swelling, Medical counselling, Paraesthesia oral — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Swollen lips (Please note that my lips started tingling immediately after the 15 minute wait and tgen my lips started swelling. This has not gone away.) · Healthcare visit (other): The 1st day of the vaccine I had this reaction and also developed a sore throat following the vaccine. Therefore, the Dr. would only see me via telehealth visit. I only have the swollen lips remaining and may need to see someone if that doesn't go away.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-25
Survey response — days 1–6 daily, dose 1
MedDRA: Lip swelling — Feeling: Fair

Free text: Lip swelling

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — days 1–6 daily, dose 1
MedDRA: Immediate post-injection reaction, Lip swelling — Feeling: Fair

Free text: Swollen Lips are still present which occurred immediately after the 15 minute wait after the vaccine was given

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Survey response — days 1–6 daily, dose 1
MedDRA: Lip swelling — Feeling: Fair · Fatigue or tiredness

Free text: Swollen lips still present

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Survey response — day 7, dose 1
MedDRA: Lip swelling — Feeling: Fair

Free text: Slightly swollen lips still present

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-11
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-18
Dose 2 — Moderna
2021-04-18
Survey response — day 0, dose 2
MedDRA: Dry throat, Eye swelling, Irritability, Lip swelling, Pharyngeal swelling — Feeling: Fair · Headache, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Lip swelling, Eye swelling, Throat felt like it was constricting, scratchy/chalk like throat feeling , irratble

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Survey response — days 1–6 daily, dose 2
MedDRA: Angioedema, Heart rate increased, Hypotension, Lip swelling, Swelling face, Swelling of eyelid — Feeling: Poor · Site: Pain, Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · 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: Angiodema, Swollen lips, Swollen eyelids, slightly swollen face, low blood pressure, increased heart rate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-20
Survey response — days 1–6 daily, dose 2
MedDRA: Angioedema, Eye swelling, Immunisation reaction, Lip swelling, Office visit, Swelling face — Feeling: Fair · Site: Pain, Redness · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Angioedemia, Lip Swelling Eye Swelling, Light facial swelling · Healthcare visit (other): Received care from Dr. yesterday and RX medication, told that Angioedema is an allergic reaction, Need to be watch my breathing and tongue, etc.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-21
Survey response — days 1–6 daily, dose 2
MedDRA: Angioedema, Hypersensitivity, Lip swelling, Swelling of eyelid — Feeling: Fair · Site: Swelling, Itching · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Angioedemia, Lip swelling, Eyelid swelling, This has been deemed an adverse allergic reaction to Moderna (possibly an ingredient in Moderna)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Survey response — days 1–6 daily, dose 2
MedDRA: Angioedema, Emergency care, Eye swelling, Immediate post-injection reaction, Lip swelling, Medical counselling, Swelling — Feeling: Fair · Site: Swelling, Itching · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Angioedema, Lip swelling, Eye swelling, (Note: Had to have medics see me onsite , reaction w/in 7 minutes, the 1st day of 2nd dose after resting my eyes began swelling had to call on call Dr. , kept monitoring my breathing as Angioedema can lead to aniophelatic shock, the 2nd day I had to go to urgent care to be seen and treated for swelling. I'm continpusly monitoring and ensuring breathing and throat, tongue stays clear or will have to call 911)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction, Angioedema, Eye swelling, Hypersensitivity, Lip swelling — Feeling: Fair · Site: Swelling, Itching · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Allergic/Adverse Reaction, Angioedema, Swelling of the lips and eyes.

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: Angioedema, Lip swelling, Swelling of eyelid — Feeling: Fair · Site: Itching · Headache, Diarrhea · Be unable to do your normal daily activities

Free text: Angioedema, Swelling of lips, Swelling of eyelids

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Survey response — day 7, dose 2
MedDRA: Angioedema, Eye swelling, Immediate post-injection reaction, Lip swelling, Medical counselling, Office visit — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Angioedema, Swelling of the lips right after the injection, Swelling of the eyes, had to seen by medics on site, then had to call Dr. that night, monitor breathing and ensure tongue didn't swell, Had to go to urgent care, treatment of swelling

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-16
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-23
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-30
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-18
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-27
Call successful
Participant prefers to complete VAERS report online
2021-10-17
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-04-18
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-21	Moderna
2	2021-04-18	Moderna

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 6 — day 0, dose 1

2021-03-21

Systemic reaction (other): I have had tingling lips which I am watching as I believe my lips have swollen a tiny bit. A sore throat started. Injection Site arm pain

Release 6 — days 1–6 daily, dose 1

2021-03-22

Systemic reaction (other): Swollen lips still

2021-03-23

Systemic reaction (other): Swollen lips, diagnosed as mild allergic reaction

2021-03-24

Systemic reaction (other): Swollen lips (Please note that my lips started tingling immediately after the 15 minute wait and tgen my lips started swelling. This has not gone away.)

Healthcare visit (other): The 1st day of the vaccine I had this reaction and also developed a sore throat following the vaccine. Therefore, the Dr. would only see me via telehealth visit. I only have the swollen lips remaining and may need to see someone if that doesn't go away.

2021-03-25

Systemic reaction (other): Lip swelling

2021-03-26

Systemic reaction (other): Swollen Lips are still present which occurred immediately after the 15 minute wait after the vaccine was given

2021-03-27

Systemic reaction (other): Swollen lips still present

Release 6 — day 7, dose 1

2021-03-28

Systemic reaction (other): Slightly swollen lips still present

Release 7 — day 0, dose 2

2021-04-18

Systemic reaction (other): Lip swelling, Eye swelling, Throat felt like it was constricting, scratchy/chalk like throat feeling , irratble

Release 7 — days 1–6 daily, dose 2

2021-04-19

Systemic reaction (other): Angiodema, Swollen lips, Swollen eyelids, slightly swollen face, low blood pressure, increased heart rate

2021-04-20

Systemic reaction (other): Angioedemia, Lip Swelling Eye Swelling, Light facial swelling

Healthcare visit (other): Received care from Dr. yesterday and RX medication, told that Angioedema is an allergic reaction, Need to be watch my breathing and tongue, etc.

2021-04-21

Systemic reaction (other): Angioedemia, Lip swelling, Eyelid swelling, This has been deemed an adverse allergic reaction to Moderna (possibly an ingredient in Moderna)

2021-04-22

Systemic reaction (other): Angioedema, Lip swelling, Eye swelling, (Note: Had to have medics see me onsite , reaction w/in 7 minutes, the 1st day of 2nd dose after resting my eyes began swelling had to call on call Dr. , kept monitoring my breathing as Angioedema can lead to aniophelatic shock, the 2nd day I had to go to urgent care to be seen and treated for swelling. I'm continpusly monitoring and ensuring breathing and throat, tongue stays clear or will have to call 911)

2021-04-23

Systemic reaction (other): Allergic/Adverse Reaction, Angioedema, Swelling of the lips and eyes.

2021-04-24

Systemic reaction (other): Angioedema, Swelling of lips, Swelling of eyelids

Release 7 — day 7, dose 2

2021-04-25

Systemic reaction (other): Angioedema, Swelling of the lips right after the injection, Swelling of the eyes, had to seen by medics on site, then had to call Dr. that night, monitor breathing and ensure tongue didn't swell, Had to go to urgent care, treatment of swelling

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	Immunisation reaction	✓	✓	✓
HCVO	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Angioedema	✓	✓	✓
SRO	Dry throat	✓	✓	✓
SRO	Emergency care	✓	✓	✓
SRO	Eye swelling	✓	✓	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Hypotension	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Irritability	✓	✓	✓
SRO	Lip swelling	✓	✓	✓
SRO	Medical counselling	✓	✓	✓
SRO	Office visit	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Paraesthesia oral	✓	✓	✓
SRO	Pharyngeal swelling	✓	✓	✓
SRO	Swelling	✓	✓	✓
SRO	Swelling face	✓	✓	✓
SRO	Swelling of eyelid	✓	✓	✓

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