5KW-68441-09105

3 vaccinations 7 coded responses 37 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 100 / NY
Registered: 2021-01-01

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2020-12-31
Dose 1 — Moderna
2021-01-01
Registered in v-safe
2021-01-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-07
Health check-in — day 7, dose 1
Feeling: Good · None

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

Adult check-in
2021-01-21
Survey response — day 21, dose 1
MedDRA: Office visit, Pregnancy, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Currently 37 weeks pregnant. In the past week have developed a severe pregnancy rash and currently being evaluated for cholestasis of pregnancy. · Healthcare visit (other): Frequent OB follow up in person and virtually

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-24
Dose 2 — Moderna
2021-01-24
Health check-in — day 0, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Vomiting · Be unable to do your normal daily activities

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-27
Survey response — days 1–6 daily, dose 2
MedDRA: Condition aggravated, Polymorphic eruption of pregnancy — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Officially diagnosed with PUPPP rash which has spread since time of vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — days 1–6 daily, dose 2
MedDRA: Exposure during pregnancy, Polymorphic eruption of pregnancy — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Continued spread of recently diagnosed PUPPP

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Rash, not including the immediate area around the injection site

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-07
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-14
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-21
Survey response — day 28, dose 2
MedDRA: Pain, Pyrexia, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Fever, body aches · Healthcare visit (other): Waiting for follow up appointment with primary care

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-26
Call 1 — Left Voicemail
2021-02-28
Survey response — day 35, dose 2
MedDRA: Cystitis, Kidney infection, Pyrexia — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Diagnosed with bladder/kidney infection and intermittent fever. Currently on antibiotics.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-03-15
Call 1 — Left Voicemail
2021-04-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-25
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-26
Dose 3 — Moderna
2021-10-26
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches · Be unable to work or attend school

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-02
Survey response — day 7, dose 3
MedDRA: Oropharyngeal pain, Sinus congestion — Feeling: Fair

Free text: Sinus congestion and sore throat

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-16
Survey response — day 21, dose 3
MedDRA: Nasal congestion, Oropharyngeal pain — Feeling: Fair

Free text: Nasal congestion and sore throat

MedDRA releases: 2024-11 · check-in free text available
2021-11-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-07
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-26
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-26
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-31	Moderna
2	2021-01-24	Moderna
3	2021-10-26	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-21	Unsuccessful
2021-02-21	Unsuccessful
2021-02-28	Unsuccessful

Free text

Release 2 — day 21, dose 1

2021-01-21

Symptoms: Currently 37 weeks pregnant. In the past week have developed a severe pregnancy rash and currently being evaluated for cholestasis of pregnancy.

Healthcare visit (other): Frequent OB follow up in person and virtually

Release 2 — days 1–6 daily, dose 2

2021-01-27

Systemic reaction (other): Officially diagnosed with PUPPP rash which has spread since time of vaccine

2021-01-28

Systemic reaction (other): Continued spread of recently diagnosed PUPPP

Release 4 — day 28, dose 2

2021-02-21

Symptoms: Fever, body aches

Healthcare visit (other): Waiting for follow up appointment with primary care

Release 4 — day 35, dose 2

2021-02-28

Symptoms: Diagnosed with bladder/kidney infection and intermittent fever. Currently on antibiotics.

Release 10 — day 7, dose 3

2021-11-02

Systemic reaction (other): Sinus congestion and sore throat

Release 10 — day 21, dose 3

2021-11-16

Symptoms: Nasal congestion and sore throat

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	Cystitis	✓	✓	✓
SD	Kidney infection	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	✓	✓	✓
SD	Pregnancy	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rash	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Exposure during pregnancy	✓	✓	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Polymorphic eruption of pregnancy	✓	✓	✓
SRO	Sinus congestion	·	·	✓

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