54Y-11054-89192

2 vaccinations 10 coded responses 23 check-ins 10 free-text entries 7 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 430 / OH
Registered: 2021-01-14

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

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Survey response — day 0, dose 1
MedDRA: Burning sensation, Lip swelling, Oral discomfort — Feeling: Fair · Headache

Free text: Burning to hands, upper lip. Slight upper lip edema.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Headache

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-16
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-17
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite, Respiratory tract congestion — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Congestion, lack of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain, Respiratory tract congestion — Feeling: Fair · Fever · Headache, Fatigue or tiredness · Be unable to work

Free text: Congestion, mild sore throat.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Report sent to call center — days 1–6 daily, dose 1
Be unable to work

1 call case(s)
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-28
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-11
Dose 2 — Moderna
2021-02-11
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain, Redness, Swelling · Headache

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · Headache, Fatigue or tiredness

Adult check-in
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain, Cough, Dyspnoea — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Chest pain 7/10 (worse w deep breath), SOB, and cough.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Call 1 — Left Voicemail
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Pruritus, Self-medication, Urticaria — Feeling: Good

Free text: Itch, redness, and hives to both forearms, hands, feet, and ankles yesterday. Improved with Benadryl. Only occasional itch and one hive today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · Headache, Fatigue or tiredness

Adult check-in
2021-02-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-12
Survey response — day 28, dose 2
MedDRA: Erythema, Joint swelling, Pruritus, Rash pruritic, Vaccine positive rechallenge — Feeling: Good

Free text: Itching to arms, hands, feet, ankles. Raised red area, approximately quarter sized to right anterior ankle. This is similar to the itching/rash experienced after the COVID-19 vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — day 35, dose 2
MedDRA: Medical observation, Pruritus — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Itching all over. OBGYN is checking labs to rule out cholystasis of pregnancy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-06
Call 1 — Left Voicemail
2021-05-13
Survey response — 3 months, dose 2
MedDRA: Delivery, Polyhydramnios — Feeling: Good · Get care from a doctor or other healthcare professional · Hospitalization

Free text: Polyhydramnios (AFI of 31 at 37 weeks); labor induced at 38 weeks. Healthy baby.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-17
Call 1 — Left Voicemail
2021-08-12
Survey response — 6 months, dose 2
MedDRA: Abdominal pain upper, Cholelithiasis, Diarrhoea, Hepatic enzyme increased, Lipase increased, Nausea, Office visit, Pruritus, Rash, Ultrasound scan abnormal, Vomiting — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Gallstones identified on ultrasound. Elevated liver enzymes and lipase. upper abdominal pain, n/v/d. GI consult. Recommended gallbladder removal. Continue to have intermittent rash/itching.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-12
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-16
Call successful
Participant prefers to complete VAERS report online
2022-02-11
Survey response — 12 months, dose 2
MedDRA: COVID-19, Cholecystectomy, Surgery — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Hospitalization

Free text: Symptoms: Gallbladder removal 10-4-21 d/t sludge/microstones. COVID-19. · Healthcare visit (other): Surgery

MedDRA releases: 2024-11 · check-in free text available
2022-02-11
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Hospitalization · 1 call case(s)
2022-02-14
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-11	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-16	Unsuccessful
2021-01-17	Unsuccessful
2021-01-18	Unsuccessful
2021-03-19	Successful	Participant prefers to complete VAERS report online
2021-05-13	Successful	Participant prefers to complete VAERS report online
2021-08-12	Successful 2021-08-16	Participant prefers to complete VAERS report online
2022-02-11	Unsuccessful

Free text

Release 2 — day 0, dose 1

2021-01-14

Systemic reaction (other): Burning to hands, upper lip. Slight upper lip edema.

Release 2 — days 1–6 daily, dose 1

2021-01-17

Systemic reaction (other): Congestion, lack of appetite

2021-01-18

Systemic reaction (other): Congestion, mild sore throat.

Release 4 — days 1–6 daily, dose 2

2021-02-14

Systemic reaction (other): Chest pain 7/10 (worse w deep breath), SOB, and cough.

2021-02-16

Systemic reaction (other): Itch, redness, and hives to both forearms, hands, feet, and ankles yesterday. Improved with Benadryl. Only occasional itch and one hive today.

Release 5 — day 28, dose 2

2021-03-12

Symptoms: Itching to arms, hands, feet, ankles. Raised red area, approximately quarter sized to right anterior ankle. This is similar to the itching/rash experienced after the COVID-19 vaccine.

Release 5 — day 35, dose 2

2021-03-19

Symptoms: Itching all over. OBGYN is checking labs to rule out cholystasis of pregnancy.

Release 8 — 3 months, dose 2

2021-05-13

Symptoms: Polyhydramnios (AFI of 31 at 37 weeks); labor induced at 38 weeks. Healthy baby.

Release 9 — 6 months, dose 2

2021-08-12

Symptoms: Gallstones identified on ultrasound. Elevated liver enzymes and lipase. upper abdominal pain, n/v/d. GI consult. Recommended gallbladder removal. Continue to have intermittent rash/itching.

Release 11 — 12 months, dose 2

2022-02-11

Symptoms: Gallbladder removal 10-4-21 d/t sludge/microstones. COVID-19.

Healthcare visit (other): Surgery

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	Surgery	·	·	✓
SD	Abdominal pain upper	✓	·	✓
SD	Cholecystectomy	·	·	✓
SD	Cholelithiasis	✓	·	✓
SD	COVID-19	·	·	✓
SD	Delivery	✓	✓	✓
SD	Diarrhoea	✓	·	✓
SD	Erythema	✓	✓	✓
SD	Hepatic enzyme increased	✓	·	✓
SD	Joint swelling	✓	✓	✓
SD	Lipase increased	✓	·	✓
SD	Medical observation	✓	✓	✓
SD	Nausea	✓	·	✓
SD	Office visit	✓	·	✓
SD	Polyhydramnios	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	·	✓
SD	Rash pruritic	✓	✓	✓
SD	Ultrasound scan abnormal	✓	·	✓
SD	Vaccine positive rechallenge	✓	✓	✓
SD	Vomiting	✓	·	✓
SRO	Burning sensation	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Lip swelling	✓	✓	✓
SRO	Oral discomfort	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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