Y27-27038-96939

2 vaccinations 10 coded responses 19 check-ins 10 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 776 / TX
Registered: 2021-03-10

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

2021-03-05
Dose 1 — Moderna
2021-03-10
Registered in v-safe
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-03-12
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-26
Survey response — day 21, dose 1
MedDRA: Adverse reaction, Erythema, Pruritus — Feeling: Fair

Free text: Covid Arm mostly itchy and still some redness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Dose 2 — Moderna
2021-03-31
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work

Adult check-in
2021-04-04
Survey response — days 1–6 daily, dose 2
MedDRA: Gingival pain, Oral mucosal blistering, Pain in jaw — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work

Free text: Mouth blisters Mouth, Gums & Jaw pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Gingival pain, Masticatory pain, Oral pain, Pain in jaw — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site

Free text: Mouth, gums and jaw pain. Hurts to chew

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Oral pain — Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site

Free text: Mouth soreness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — day 7, dose 2
MedDRA: Stomatitis — Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site

Free text: Mouth sores are improving

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

Free text: Rash on chest is more widespread and itches bad

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

Free text: The rash on my chest has expanded to the clavicle area and dLIts u def left arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Survey response — day 28, dose 2
MedDRA: Blister, Rash — Feeling: Fair · Be unable to do your normal daily activities

Free text: Horrible rash and soR turned to blisters

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Survey response — day 35, dose 2
MedDRA: Rash, Rash pruritic — Feeling: Fair

Free text: Skin rash still on chest and itching bad

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Survey response — day 42, dose 2
MedDRA: Erythema, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Rash and redness has gotten worse

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-29
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-05-05
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-05	Moderna
2	2021-03-31	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-05-12	Unsuccessful

Free text

Release 6 — day 21, dose 1

2021-03-26

Symptoms: Covid Arm mostly itchy and still some redness

Release 6 — days 1–6 daily, dose 2

2021-04-04

Systemic reaction (other): Mouth blisters Mouth, Gums & Jaw pain

2021-04-05

Systemic reaction (other): Mouth, gums and jaw pain. Hurts to chew

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): Mouth soreness

Release 7 — day 7, dose 2

2021-04-07

Systemic reaction (other): Mouth sores are improving

Release 7 — day 14, dose 2

2021-04-14

Symptoms: Rash on chest is more widespread and itches bad

Release 7 — day 21, dose 2

2021-04-21

Symptoms: The rash on my chest has expanded to the clavicle area and dLIts u def left arm

Release 8 — day 28, dose 2

2021-04-28

Symptoms: Horrible rash and soR turned to blisters

Release 8 — day 35, dose 2

2021-05-05

Symptoms: Skin rash still on chest and itching bad

Release 8 — day 42, dose 2

2021-05-12

Symptoms: Rash and redness has gotten worse

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	Adverse reaction	✓	✓	✓
SD	Blister	✓	✓	✓
SD	Erythema	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SRO	Gingival pain	✓	✓	✓
SRO	Masticatory pain	✓	✓	✓
SRO	Oral mucosal blistering	✓	✓	✓
SRO	Oral pain	✓	✓	✓
SRO	Pain in jaw	✓	✓	✓
SRO	Stomatitis	✓	✓	✓

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