5VA-31814-55467

2 vaccinations 5 coded responses 22 check-ins 5 free-text entries 3 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 982 / WA
Registered: 2021-01-29

Relationship: Self
Race: American Indian or Alaska Native
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-29
Registered in v-safe
2021-01-29
Dose 1 — Moderna
2021-01-29
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Rash, not including the immediate area around the injection site

Adult check-in
2021-01-30
Survey response — days 1–6 daily, dose 1
MedDRA: Urticaria — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: A few hives on my face

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

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-05
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-14
Survey response — day 14, dose 1
MedDRA: Cystitis — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I was treated for a bladder infection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-26
Dose 2 — Moderna
2021-02-27
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction, Pre-existing disease — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: I have mast cell activation syndrome so my reaction was expected to be like this

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
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 · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · None

Adult check-in
2021-03-08
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-09
Survey response — day 42, dose 2
MedDRA: Condition aggravated, Office visit, Pre-existing disease — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Im experiencing a very big MCAS flare. · Healthcare visit (other): In person visits with doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Report sent to call center — day 42, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-06-14
Call 1 — Left Voicemail
2021-06-14
Call successful
Participant prefers to complete VAERS report online
2021-08-27
Survey response — 6 months, dose 2
MedDRA: Electrocardiogram abnormal, Emergency care, Office visit, Unevaluable event, Ventricular extrasystoles — 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 · Hospitalization

Free text: Symptoms: I had an abnormal EKG at my primary care doctors office and was sent to hospital. Initial testing says Im having premature ventricular contractions. More testing is scheduled. · Healthcare visit (other): Just for a day for cardiac minitoring

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-27
Report sent to call center — 6 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

1 call case(s)
2021-09-02
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-29	Moderna
2	2021-02-26	Moderna

Call center

3 call center cases

2 successful · 1 unsuccessful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-01-30

Systemic reaction (other): A few hives on my face

Release 4 — day 14, dose 1

2021-02-14

Symptoms: I was treated for a bladder infection.

Release 4 — days 1–6 daily, dose 2

2021-02-27

Systemic reaction (other): I have mast cell activation syndrome so my reaction was expected to be like this

Release 7 — day 42, dose 2

2021-04-09

Symptoms: Im experiencing a very big MCAS flare.

Healthcare visit (other): In person visits with doctor

Release 9 — 6 months, dose 2

2021-08-27

Symptoms: I had an abnormal EKG at my primary care doctors office and was sent to hospital. Initial testing says Im having premature ventricular contractions. More testing is scheduled.

Healthcare visit (other): Just for a day for cardiac minitoring

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	Condition aggravated	✓	✓	✓
SD	Cystitis	✓	✓	✓
SD	Electrocardiogram abnormal	✓	·	✓
SD	Emergency care	✓	·	✓
SD	Office visit	✓	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Ventricular extrasystoles	✓	·	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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