65M-32831-88361
3 vaccinations
11 coded responses
27 check-ins
11 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 231 / VA
- Registered
- 2021-01-20
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-20
Registered in v-safe
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2021-01-20
Dose 1 — Moderna
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2021-01-22
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: Fair · Site: Itching · Chills, Fatigue or tiredness, DiarrheaFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-23
Survey response — days 1–6 daily, dose 1MedDRA: Pruritus — Feeling: Good · DiarrheaFree text: Not today! The itching was on night of and was on both arms - but has not reappeared since severe, bMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-24
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2021-01-25
Survey response — days 1–6 daily, dose 1MedDRA: Pruritus — Feeling: Good · Site: Itching · Diarrhea · Be unable to do your normal daily activitiesFree text: No, but itching more global parts of body vs both arms previously.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-26
Survey response — days 1–6 daily, dose 1MedDRA: Adverse reaction, Self-medication — Feeling: Good · DiarrheaFree text: Just re issue above. Am taking Pepto Bismol to prevent interruption of my appointments. Ok?MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-27
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2021-02-03
Survey response — day 14, dose 1MedDRA: Injection site pruritus, Urticaria — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Hives taking over my life - especially in the morning. They are my hands and fingers - especially the left hand. Had my vaccination on right arm. Prior to that a couple of days ago there had been severe itching ar point of injection. That no longer.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-10
- 2021-02-19
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2021-02-24
Survey response — day 35, dose 1MedDRA: Urticaria — Feeling: Fair · Be unable to do your normal daily activitiesFree text: I continue to wake from time snatching furiously I have a history of severe hives - and they were very severe a couple of weeks ago. In past years ive had them to a degree that it was close yo being anaphlactic. A second shot could be severe.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-03
- 2021-04-22
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2021-04-29
Dose 2 — Moderna
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2021-05-01
Survey response — days 1–6 daily, dose 2MedDRA: No adverse event — Feeling: Good · Site: Redness, Swelling, Itching · Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-02
Survey response — days 1–6 daily, dose 2MedDRA: Injection site erythema, Rash — Feeling: Good · Site: Redness, Swelling, ItchingFree text: Injection site has bright red center like blood and large rash on upper arm - outside. Also, injection site this time on left arm, at times, seems to activate feeling in injection site on right arm.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-03
Survey response — days 1–6 daily, dose 2MedDRA: Adverse reaction — Feeling: Good · Site: Redness, ItchingFree text: Better, todayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-04
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Itching · NoneAdult check-in
- 2021-05-05
- 2021-05-06
- 2021-05-13
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2021-05-20
Survey response — day 21, dose 2MedDRA: Limb discomfort — Feeling: GoodFree text: Its on and off- mentioned once before: the right arm where I received the first shot, seems to be activated occasionally by my left arm (2nd shot) at the entry spot with like a throbbing-like effect. As that been reported often?MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-28
- 2021-06-03
- 2021-06-10
- 2021-07-29
- 2021-10-28
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2021-11-12
Dose 3 — Moderna
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2022-04-29
Survey response — 12 months, dose 2MedDRA: Medical counselling, Skin disorder — Feeling: GoodFree text: Developed a cap-like of cement gravel on entire scalp. Dermatologist said plaque? Have me drops & special shampoo. Much gone but still patches. Started about 5 months ago.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-20 | Moderna | |
| 2 | 2021-04-29 | Moderna | |
| 3 | 2021-11-12 | Moderna | No |
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): No
Systemic reaction (other): Not today! The itching was on night of and was on both arms - but has not reappeared since severe, b
Systemic reaction (other): No, but itching more global parts of body vs both arms previously.
Systemic reaction (other): Just re issue above. Am taking Pepto Bismol to prevent interruption of my appointments. Ok?
Release 3 — day 14, dose 1
Symptoms: Hives taking over my life - especially in the morning. They are my hands and fingers - especially the left hand. Had my vaccination on right arm. Prior to that a couple of days ago there had been severe itching ar point of injection. That no longer. cut off by CDC
Release 4 — day 35, dose 1
Symptoms: I continue to wake from time snatching furiously I have a history of severe hives - and they were very severe a couple of weeks ago. In past years ive had them to a degree that it was close yo being anaphlactic. A second shot could be severe.
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): No
Systemic reaction (other): Injection site has bright red center like blood and large rash on upper arm - outside. Also, injection site this time on left arm, at times, seems to activate feeling in injection site on right arm.
Systemic reaction (other): Better, today
Release 8 — day 21, dose 2
Symptoms: Its on and off- mentioned once before: the right arm where I received the first shot, seems to be activated occasionally by my left arm (2nd shot) at the entry spot with like a throbbing-like effect. As that been reported often?
Release 11 — 12 months, dose 2
Symptoms: Developed a cap-like of cement gravel on entire scalp. Dermatologist said plaque? Have me drops & special shampoo. Much gone but still patches. Started about 5 months ago.
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 |
|---|---|---|---|---|
| SD | Injection site pruritus | ✓ | ✓ | ✓ |
| SD | Limb discomfort | ✓ | ✓ | ✓ |
| SD | Medical counselling | · | · | ✓ |
| SD | Skin disorder | · | · | ✓ |
| SD | Urticaria | ✓ | ✓ | ✓ |
| SRO | Adverse reaction | ✓ | ✓ | ✓ |
| SRO | Injection site erythema | ✓ | ✓ | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
| SRO | Rash | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release