KJA-10831-15711

4 vaccinations 3 coded responses 46 check-ins 3 free-text entries 1 call case

Sex: Female
Age at first dose: 36-40
ZIP prefix: 051 / VT
Registered: 2020-12-23

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

Registered dependents

7XS-19971-78281 Child or adolescent in my care · Female · 2022-08-28

LSB-50731-67483 Child or adolescent in my care · Male · 2022-08-28

Timeline

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

2020-12-23
Registered in v-safe
2020-12-23
Dose 1 — Moderna
2020-12-23
Survey response — day 0, dose 1
MedDRA: Erythema, Immediate post-injection reaction — Feeling: Good

Free text: Cheeks became red within 30 minutes of vaccine, no environmental changes could explain this.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2020-12-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2020-12-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-30
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-06
Survey response — day 14, dose 1
MedDRA: Inflammation, Injection site rash, Office visit, Pruritus — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: I developed a large rash around the injection site. It spanned from the injection, around my arm and to the elbow. It developed a week after receiving the vaccine and is still present. Hydrocortisone cream has helped the inflammation and itch. · Healthcare visit (other): Also, saw the employee health nurse

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-06
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-21
Dose 2 — Moderna
2021-01-21
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-01-22
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Itching · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness, Diarrhea

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Headache, Diarrhea

Adult check-in
2021-01-28
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · Diarrhea

Adult check-in
2021-02-04
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-11
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-15
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2021-02-18
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-28
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-22
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-26
Dose 3 — Moderna
2021-10-26
Health check-in — day 0, dose 3
Feeling: Good · Site: Itching · None

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Joint pains, Fatigue or tiredness

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling, Itching · Joint pains, Muscle or body aches

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Diarrhea

Adult check-in
2021-11-02
Health check-in — day 7, dose 3
Feeling: Fair · Site: Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-09
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-16
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-07
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-26
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-08-24
Dose 4 — Moderna
2022-08-28
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Redness, Swelling, Itching · Muscle or body aches, Rash, not including the immediate area around the injection site

Adult check-in
2022-08-29
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Redness, Swelling, Itching · Muscle or body aches

Adult check-in
2022-08-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Itching · Rash, not including the immediate area around the injection site

Adult check-in
2022-08-31
Health check-in — day 7, dose 4
Feeling: Good · Site: Itching · Rash, not including the immediate area around the injection site

Adult check-in
2022-09-07
Survey response — day 14, dose 4
MedDRA: Ageusia, Anosmia, Nasal congestion, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test negative — Feeling: Poor · Be unable to do your normal daily activities

Free text: Stuffy nose, sore throat, fever, loss of taste and smell. COVID negative so far.

MedDRA releases: 2024-11 · check-in free text available
2022-09-16
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-09-21
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-09-28
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-10-05
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-23	Moderna
2	2021-01-21	Moderna
3	2021-10-26	Moderna	No
4	2022-08-24	Moderna	No

Call center

1 call center case

1 successful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 1 — day 0, dose 1

2020-12-23

Systemic reaction (other): Cheeks became red within 30 minutes of vaccine, no environmental changes could explain this.

Release 1 — day 14, dose 1

2021-01-06

Symptoms: I developed a large rash around the injection site. It spanned from the injection, around my arm and to the elbow. It developed a week after receiving the vaccine and is still present. Hydrocortisone cream has helped the inflammation and itch.

Healthcare visit (other): Also, saw the employee health nurse

Release 12 — day 14, dose 4

2022-09-07

Symptoms: Stuffy nose, sore throat, fever, loss of taste and smell. COVID negative so far.

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 observation	○	○	○
HCVO	Office visit	✓	✓	✓
SD	Ageusia	·	·	✓
SD	Anosmia	·	·	✓
SD	Inflammation	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pruritus	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	Rash	○	○	○
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Erythema	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓

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