5QQ-50435-79952

2 vaccinations 7 coded responses 23 check-ins 7 free-text entries 6 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 921 / CA
Registered: 2020-12-30

Relationship: Self
Race: American Indian or Alaska Native
Ethnicity: Hispanic or Latino

Timeline

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

2020-12-30
Registered in v-safe
2020-12-30
Dose 1 — Moderna
2020-12-30
Health check-in — day 0, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2020-12-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-01
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus, Skin discolouration — Feeling: Good · Fatigue or tiredness

Free text: Had a mild discoloration previously under rt arm pit and it increased and started itching after shot not sure if it's related.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-03
Survey response — days 1–6 daily, dose 1
MedDRA: Musculoskeletal stiffness — Feeling: Good · Fever · Muscle or body aches

Free text: 1st 3 days had unusual neck stiffness and today a little of same

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-04
Survey response — days 1–6 daily, dose 1
MedDRA: Neck pain, Pain in jaw — Feeling: Fair · Fever · Joint pains, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Pain at jaw and neck

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

1 call case(s)
2021-01-05
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-05
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-07
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-01-07
Report sent to call center — day 7, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-13
Survey response — day 14, dose 1
MedDRA: Rash, Rash pruritic — Feeling: Fair

Free text: New rash on left arm. Rt arm rash itching more

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-27
Dose 2 — Moderna
2021-01-27
Survey response — day 0, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Still have rash right armpit maybe previous. Using anti fungal cream · Healthcare visit (other): Appointment set for Thursday morning

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — day 0, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Adult check-in
2021-01-28
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-30
Survey response — days 1–6 daily, dose 2
MedDRA: Irritability, Rash — Feeling: Good · Fatigue or tiredness

Free text: Irritability. Rash right arm pit from previous mild

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-02-02
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Unevaluable event — Feeling: Good · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Discoloration left arm pit - reddish line appeared · Healthcare visit (other): Scheduled voice appointment fridayt

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-03
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-10
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 28, dose 2
Feeling: Good

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

Adult check-in
2021-03-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-12
Call successful
Completed over the phone

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-30	Moderna
2	2021-01-27	Moderna

Call center

6 call center cases

3 successful · 3 priority 2/3 (triaged and no follow up)

VAERS report filed, before or during a call: 3

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-01

Systemic reaction (other): Had a mild discoloration previously under rt arm pit and it increased and started itching after shot not sure if it's related.

2021-01-03

Systemic reaction (other): 1st 3 days had unusual neck stiffness and today a little of same

2021-01-04

Systemic reaction (other): Pain at jaw and neck

Release 1 — day 14, dose 1

2021-01-13

Symptoms: New rash on left arm. Rt arm rash itching more

Release 2 — day 0, dose 2

2021-01-27

Systemic reaction (other): Still have rash right armpit maybe previous. Using anti fungal cream

Healthcare visit (other): Appointment set for Thursday morning

Release 3 — days 1–6 daily, dose 2

2021-01-30

Systemic reaction (other): Irritability. Rash right arm pit from previous mild

2021-02-02

Systemic reaction (other): Discoloration left arm pit - reddish line appeared

Healthcare visit (other): Scheduled voice appointment fridayt

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	Unevaluable event	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Irritability	✓	✓	✓
SRO	Musculoskeletal stiffness	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Pain in jaw	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Skin discolouration	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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