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64J-14012-67705

4 vaccinations 8 coded responses 26 check-ins 8 free-text entries 4 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
913 / CA
Registered
2021-03-19
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-16
    Dose 1 — Moderna
  2. 2021-03-17
    Dose 2 — Moderna
  3. 2021-03-19
    Registered in v-safe
  4. 2021-03-19
    Survey response — days 1–6 daily, dose 2
    MedDRA: Erythema, Feeling hot, Headache, Pruritus, Pyrexia, Somnolence — Feeling: Good · Site: Pain, Redness, Itching · Be unable to work, Be unable to do your normal daily activities
    Free text: Developed redness on right arm 20-days after first vaccine. Size -2.5x1. No itching. It was several inches from the injection site and bright red. With 2nd vaccine, took it in opposite arm and developed redness and very slight itching the day after. It has been 2-days post vaccine and it is still red. This one is considerably larger: 3.75 x 2.25 and warm to touch. On advice of allergist, have been taking Allegra since the day before the 2nd vaccine. Apparently had no effect on the redness. I also ran a low grade temp yesterday: 99.5 at the highest. My normal is 97ish and was 97.3 at time of injection. Also noted yesterday, very slight headache and sleepiness.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-03-20
    Survey response — days 1–6 daily, dose 2
    MedDRA: Erythema — Feeling: Good · Site: Pain, Redness, Itching
    Free text: Want to make a correction to previous report. Accidentally reported redness on right arm after the first vaccine occurred 20 days after the injection, but was unable to correct it. It occurred 10 (ten) days after the first vaccine.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-03-21
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain, Redness · None
    Adult check-in
  7. 2021-03-22
    Survey response — days 1–6 daily, dose 2
    MedDRA: Erythema — Feeling: Good · Site: Redness · Headache
    Free text: Redness has almost completely faded
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-03-23
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Headache
    Adult check-in
  9. 2021-03-24
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  10. 2021-03-31
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  11. 2021-04-07
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  12. 2021-04-14
    Survey response — day 28, dose 2
    MedDRA: Headache — Feeling: Fair
    Free text: Headache
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-04-21
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  14. 2021-04-29
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  15. 2021-06-16
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  16. 2021-09-15
    Survey response — 6 months, dose 2
    MedDRA: C-reactive protein increased, Eye inflammation, Red blood cell sedimentation rate increased — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Inflammation of eyes and elevated ESR & CRP
    MedDRA releases: 2024-11 · check-in free text available
  17. 2021-09-15
    Report sent to call center — 6 months, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  18. 2021-09-19
  19. 2021-09-21
  20. 2021-09-21
    Call successful
    Participant prefers to complete VAERS report online
  21. 2021-10-29
    Dose 3 — Moderna
  22. 2022-03-18
    Health check-in — 12 months, dose 2
    Feeling: Good
    Adult check-in
  23. 2022-04-22
    Dose 4 — Moderna
  24. 2022-04-26
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · Site: Pain, Redness · None
    Adult check-in
  25. 2022-04-27
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  26. 2022-04-28
    Survey response — days 1–6 daily, dose 4
    MedDRA: Blood glucose decreased, Medical counselling — Feeling: Fair · Site: Redness · Fatigue or tiredness · Get care from a doctor or other healthcare professional
    Free text: Systemic reaction (other): Since receiving this booster, blood glucose levels have dropped · Healthcare visit (other): Email. Seeing Dr. next week.
    MedDRA releases: 2024-11 · check-in free text available
  27. 2022-04-28
    Report sent to call center — days 1–6 daily, dose 4
    Get care from a doctor or other healthcare professional
    1 call case(s)
  28. 2022-04-29
    Health check-in — day 7, dose 4
    Feeling: Good · Site: Redness · None
    Adult check-in
  29. 2022-04-29
    Call successful
    Not applicable - Accidental Reporting
  30. 2022-05-06
    Health check-in — day 14, dose 4
    Feeling: Good
    Adult check-in
  31. 2022-05-13
    Health check-in — day 21, dose 4
    Feeling: Good
    Adult check-in
  32. 2022-05-20
    Health check-in — day 28, dose 4
    Feeling: Good
    Adult check-in
  33. 2022-05-27
    Health check-in — day 35, dose 4
    Feeling: Good
    Adult check-in
  34. 2022-06-03
    Health check-in — day 42, dose 4
    Feeling: Good
    Adult check-in
  35. 2022-07-22
    Survey response — 3 months, dose 4
    MedDRA: Laboratory test abnormal, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional
    Free text: Symptoms: Abnormal lab tests · Healthcare visit (other): Dr Office
    MedDRA releases: 2024-11 · check-in free text available
  36. 2022-07-22
    Report sent to call center — 3 months, dose 4
    Get care from a doctor or other healthcare professional
    1 call case(s)
  37. 2022-07-25
  38. 2022-07-25
  39. 2022-07-25
  40. 2022-07-25
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  41. 2022-10-21
    Survey response — 6 months, dose 4
    MedDRA: Antiphospholipid syndrome — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Have developed antiphospholipid syndrome
    MedDRA releases: 2024-11 · check-in free text available
  42. 2022-10-21
    Report sent to call center — 6 months, dose 4
    Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  43. 2022-10-24
  44. 2023-04-22
    Health check-in — 12 months, dose 4
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-02-16Moderna
22021-03-17Moderna
32021-10-29Moderna No
42022-04-22Moderna No

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-19

Systemic reaction (other): Developed redness on right arm 20-days after first vaccine. Size -2.5x1. No itching. It was several inches from the injection site and bright red. With 2nd vaccine, took it in opposite arm and developed redness and very slight itching the day after. It has been 2-days post vaccine and it is still red. This one is considerably larger: 3.75 x 2.25 and warm to touch. On advice of allergist, have been taking Allegra since the day before the 2nd vaccine. Apparently had no effect on the redness. I also ran a low grade temp yesterday: 99.5 at the highest. My normal is 97ish and was 97.3 at time of injection. Also noted yesterday, very slight headache and sleepiness.

2021-03-20

Systemic reaction (other): Want to make a correction to previous report. Accidentally reported redness on right arm after the first vaccine occurred 20 days after the injection, but was unable to correct it. It occurred 10 (ten) days after the first vaccine.

2021-03-22

Systemic reaction (other): Redness has almost completely faded

Release 7 — day 28, dose 2

2021-04-14

Symptoms: Headache

Release 9 — 6 months, dose 2

2021-09-15

Symptoms: Inflammation of eyes and elevated ESR & CRP

Release 11 — days 1–6 daily, dose 4

2022-04-28

Systemic reaction (other): Since receiving this booster, blood glucose levels have dropped
Healthcare visit (other): Email. Seeing Dr. next week.

Release 12 — 3 months, dose 4

2022-07-22

Symptoms: Abnormal lab tests
Healthcare visit (other): Dr Office

Release 12 — 6 months, dose 4

2022-10-21

Symptoms: Have developed antiphospholipid syndrome

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

FieldPreferred term2021-092023-042024-11
HCVOMedical counselling · · ✓
HCVOOffice visit · · ✓
SDAntiphospholipid syndrome · · ✓
SDC-reactive protein increased · · ✓
SDEye inflammation · · ✓
SDHeadache ✓ ✓ ✓
SDLaboratory test abnormal · · ✓
SDRed blood cell sedimentation rate increased · · ✓
SROBlood glucose decreased · · ✓
SROErythema ✓ ✓ ✓
SROFeeling hot ✓ ✓ ✓
SROHeadache ✓ ✓ ✓
SROPruritus ✓ ✓ ✓
SROPyrexia ✓ ✓ ✓
SROSomnolence ✓ ✓ ✓

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

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