6GJ-83918-89522

2 vaccinations 15 coded responses 25 check-ins 15 free-text entries 4 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 440 / OH
Registered: 2021-02-10

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-10
Registered in v-safe
2021-02-10
Dose 1 — Moderna
2021-02-10
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-11
Survey response — days 1–6 daily, dose 1
MedDRA: Agitation, Erythema, Hypertension, Rash, Self-medication, Skin warm — Feeling: Fair · Site: Pain · Rash, not including the immediate area around the injection site

Free text: Yesterday around 6:30 PM left ear was red and very hot. Felt agitated. Took 25 mg Benadryl. At 9:00 PM saw rash on upper chest and upper back. Blood pressure high. Took another 25 mg Benadryl. In morning rash mostly gone and blood pressure normal,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness · Joint pains, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness · Joint pains

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · Joint pains

Adult check-in
2021-02-17
Health check-in — day 7, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-24
Survey response — day 14, dose 1
MedDRA: Agitation, Office visit, Pruritus, Rash, Rhinorrhoea, Urticaria — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: RashHivesItchingRunny noseAgitation · Healthcare visit (other): in office visit -Family Physician who then referred me to Allergy doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-03
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-10
Dose 2 — Moderna
2021-03-10
Survey response — day 0, dose 2
MedDRA: Rash macular — Feeling: Good · Site: Pain, Redness · Rash, not including the immediate area around the injection site

Free text: Arms are blotchy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Livedo reticularis, Paraesthesia oral, Rash, Skin irritation — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Tightness on scalp, rash both knees, rash on hairline, clothes felt scratchy, left thumb bright red, mottled skin on back of both upper arms, lips tingling

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-03-13
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus, Restlessness — Feeling: Good · Site: Pain · Joint pains, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Itching, restlessness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus, Restlessness — Feeling: Good · Site: Pain · Joint pains, Rash, not including the immediate area around the injection site

Free text: Restlessness, itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Blood pressure increased, Erythema, Livedo reticularis, Medical counselling, Palmar erythema, Paraesthesia, Rash, Sensitive skin, Urticaria — Feeling: Good · Joint pains, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Left ear and palms were red, mottled arms, hives, high blood pressure, tingling in arms, skin sensitive- clothes felt scratchy · Healthcare visit (other): Phone call to doctor for prescription for rash

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Mottled arms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 7, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-03-24
Survey response — day 14, dose 2
MedDRA: Office visit, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Rash on left neck since Day 1 of the first vaccine shot. Rash has gotten worse since the second vaccine shot. Now it is on both sides of my neck, my chest and upper back and back of my knees, spreading to stomach. Doctor has me on 3 antihistamines. · Healthcare visit (other): Office visit- After first shot and before second shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-31
Survey response — day 21, dose 2
MedDRA: Pruritus, Rash, Rash erythematous — Feeling: Good

Free text: Rash is still on neck and upper back. It flares up and goes to my upper stomach and sides, then receeds. There is a red ruddy patch of skin on the back of my neck about 5 inches across with uneven borders. Itching on arms and legs.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — day 28, dose 2
MedDRA: Pain of skin, Pruritus, Rash, Urticaria — Feeling: Good

Free text: Itching and hives on left collarbone today. Scalp is very sore. Rash has been on back of neck since Feb 10.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — day 35, dose 2
MedDRA: Rash, Urticaria — Feeling: Good

Free text: Hives on 3 days this week. On left sde of face, left ear lobe, left inside forearm. Still have rash on back of neck that appeared on first day of first shot and has never left.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Survey response — day 42, dose 2
MedDRA: Rash — Feeling: Good

Free text: Two days this week , the rash expanded from the back of my neck to my upper chest, upper stomach and upper back.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-10
Survey response — 3 months, dose 2
MedDRA: Office visit, Rash — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Rash on back of neck, with bumps ,and on scalpItching.Rash has been there since the day I received the first shot.A few episodes of rash on chest and upper back that would last for about 24 hours · Healthcare visit (other): 2 office visits. One with an allergist and one with a dermatologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-10
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-17
Call 1 — Left Voicemail
2021-07-02
Call successful
Participant prefers to complete VAERS report online
2021-09-13
Survey response — 6 months, dose 2
MedDRA: Blood blister, Oral mucosal blistering — Feeling: Good

Free text: Blood blisters inside mouth

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-10	Moderna
2	2021-03-10	Moderna

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-11

Systemic reaction (other): Yesterday around 6:30 PM left ear was red and very hot. Felt agitated. Took 25 mg Benadryl. At 9:00 PM saw rash on upper chest and upper back. Blood pressure high. Took another 25 mg Benadryl. In morning rash mostly gone and blood pressure normal,

Release 4 — day 14, dose 1

2021-02-24

Symptoms: RashHivesItchingRunny noseAgitation

Healthcare visit (other): in office visit -Family Physician who then referred me to Allergy doctor

Release 5 — day 0, dose 2

2021-03-10

Systemic reaction (other): Arms are blotchy

Release 5 — days 1–6 daily, dose 2

2021-03-11

Systemic reaction (other): Tightness on scalp, rash both knees, rash on hairline, clothes felt scratchy, left thumb bright red, mottled skin on back of both upper arms, lips tingling

2021-03-13

Systemic reaction (other): Itching, restlessness

2021-03-14

Systemic reaction (other): Restlessness, itching

2021-03-15

Systemic reaction (other): Left ear and palms were red, mottled arms, hives, high blood pressure, tingling in arms, skin sensitive- clothes felt scratchy

Healthcare visit (other): Phone call to doctor for prescription for rash

2021-03-16

Systemic reaction (other): Mottled arms

Release 6 — day 14, dose 2

2021-03-24

Symptoms: Rash on left neck since Day 1 of the first vaccine shot. Rash has gotten worse since the second vaccine shot. Now it is on both sides of my neck, my chest and upper back and back of my knees, spreading to stomach. Doctor has me on 3 antihistamines. cut off by CDC

Healthcare visit (other): Office visit- After first shot and before second shot.

Release 6 — day 21, dose 2

2021-03-31

Symptoms: Rash is still on neck and upper back. It flares up and goes to my upper stomach and sides, then receeds. There is a red ruddy patch of skin on the back of my neck about 5 inches across with uneven borders. Itching on arms and legs.

Release 7 — day 28, dose 2

2021-04-07

Symptoms: Itching and hives on left collarbone today. Scalp is very sore. Rash has been on back of neck since Feb 10.

Release 7 — day 35, dose 2

2021-04-14

Symptoms: Hives on 3 days this week. On left sde of face, left ear lobe, left inside forearm. Still have rash on back of neck that appeared on first day of first shot and has never left.

Release 7 — day 42, dose 2

2021-04-21

Symptoms: Two days this week , the rash expanded from the back of my neck to my upper chest, upper stomach and upper back.

Release 9 — 3 months, dose 2

2021-06-10

Symptoms: Rash on back of neck, with bumps ,and on scalpItching.Rash has been there since the day I received the first shot.A few episodes of rash on chest and upper back that would last for about 24 hours

Healthcare visit (other): 2 office visits. One with an allergist and one with a dermatologist

Release 9 — 6 months, dose 2

2021-09-13

Symptoms: Blood blisters inside mouth

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	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Rash	✓	✓	✓
SD	Agitation	✓	✓	✓
SD	Blood blister	·	·	✓
SD	Oral mucosal blistering	·	·	✓
SD	Pain of skin	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash erythematous	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Urticaria	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Agitation	✓	✓	✓
SRO	Blood pressure increased	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Hypertension	✓	✓	✓
SRO	Livedo reticularis	✓	✓	✓
SRO	Palmar erythema	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Paraesthesia oral	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Rash macular	✓	✓	✓
SRO	Restlessness	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Sensitive skin	✓	✓	✓
SRO	Skin irritation	✓	✓	✓
SRO	Skin warm	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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