966-12968-15231

3 vaccinations 5 coded responses 9 check-ins 4 free-text entries 5 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 930 / CA
Registered: 2021-06-09

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

2021-04-02
Dose 1 — Moderna
2021-04-30
Dose 2 — Moderna
2021-06-09
Registered in v-safe
2021-06-09
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-06-11
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-30
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-29
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-01-12
Dose 3 — Moderna
Co-administered: Flu
2022-01-25
Survey response — day 7, dose 3
MedDRA: Erythema multiforme, Office visit — Feeling: Poor · Headache, Joint pains, Diarrhea, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Full body classic Erythema multiforme developed 01/23/22. Dermatologist indicated likely caused by Covid booster and flu shot being administered on same day.

MedDRA releases: 2024-11 · check-in free text available
2022-01-25
Report sent to call center — day 7, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-26
Survey response — day 14, dose 3
MedDRA: Pre-existing disease, Rash — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Rash is flaring up and getting worse

MedDRA releases: 2024-11 · check-in free text available
2022-01-26
Report sent to call center — day 14, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-26
Call successful
Participant prefers to complete VAERS report online
2022-01-28
Call successful
Participant prefers to complete VAERS report online
2022-04-13
Survey response — 3 months, dose 3
MedDRA: Self-medication, Urticaria — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Chronic hives that have not resolved for 11+ weeks. Even after several steroid shots and multiple antihistamines

MedDRA releases: 2024-11 · check-in free text available
2022-04-13
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-14
Call 1 — Left Voicemail
2022-04-18
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-07-13
Survey response — 6 months, dose 3
MedDRA: Autoimmune disorder, Urticaria chronic — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I have some sort of autoimmune markers present now (post CV booster in Jan,2022). I continue to experience chronic hives every single day, despite 6 different antihistamines and multiple rounds of steroids

MedDRA releases: 2024-11 · check-in free text available
2022-07-13
Report sent to call center — 6 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-07-14
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2023-01-12
Survey response — 12 months, dose 3
MedDRA: Cardiac disorder, Unevaluable event, Ventricular tachycardia — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-01-12
Report sent to call center — 12 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-01-13
Call successful
Reported to VAERS voluntarily prior to GDIT contact

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-02	Moderna
2	2021-04-30	Moderna
3	2022-01-12	Moderna	Flu

Call center

5 call center cases

5 successful

VAERS report filed, before or during a call: 3

See the call center timeline

Free text

Release 11 — day 7, dose 3

2022-01-25

Systemic reaction (other): Full body classic Erythema multiforme developed 01/23/22. Dermatologist indicated likely caused by Covid booster and flu shot being administered on same day.

Release 11 — day 14, dose 3

2022-01-26

Symptoms: Rash is flaring up and getting worse

Release 11 — 3 months, dose 3

2022-04-13

Symptoms: Chronic hives that have not resolved for 11+ weeks. Even after several steroid shots and multiple antihistamines

Release 12 — 6 months, dose 3

2022-07-13

Symptoms: I have some sort of autoimmune markers present now (post CV booster in Jan,2022). I continue to experience chronic hives every single day, despite 6 different antihistamines and multiple rounds of steroids

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	Autoimmune disorder	·	·	✓
SD	Cardiac disorder	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Rash	·	·	✓
SD	Self-medication	·	·	✓
SD	Urticaria	·	·	✓
SD	Urticaria chronic	·	·	✓
SD	Ventricular tachycardia	·	·	✓
SRO	Erythema multiforme	·	·	✓
SRO	Office visit	·	·	✓

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