Y34-17421-04154

2 vaccinations 14 coded responses 17 check-ins 14 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 088 / NJ
Registered: 2021-03-24

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

2021-03-24
Registered in v-safe
2021-03-24
Dose 1 — Moderna
2021-03-24
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-25
Survey response — days 1–6 daily, dose 1
MedDRA: Palpitations — Feeling: Good · Site: Itching · Fatigue or tiredness

Free text: Felt like racy heart beat after dinner yesterday and today now near mid nite. Had these symptoms before moderna but feel like more pronounced now after get shot yesterday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Survey response — days 1–6 daily, dose 1
MedDRA: Back disorder, Self-medication — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: Will take Tylenol 4 symptoms above as very mild and may also be due back problem.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-30
Survey response — days 1–6 daily, dose 1
MedDRA: Flatulence — Feeling: Good

Free text: More gas today than usual all day long. Had it also 2 days ago but Seems worse today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — day 7, dose 1
MedDRA: Condition aggravated, Medical counselling, Pre-existing disease, Rash, Self-medication — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Forgot 2 say 3 days after had shot on 3/24 I had more of rash on my nose when took hit shower. Had very mild case of dermagraphia before got shot w. Hives on nose and my Doc said I might get more hives after shot since vaccine heightens immune response which I did. Took Allegra OTC which my Docs been treating me with even before shot and it lasted less than a day. Reappears than disappears after few hours. Sorry forgot mention earlier as had more nose hives or 2 days but Doc said might occur since had detmagraphia even before vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — day 14, dose 1
MedDRA: Fatigue, Pain, Rash, Rash pruritic — Feeling: Fair

Free text: Bit achy today & yesterday. Took 2 Tylenol and feelMore tired this eve. More rash lines on my chest which I get from my dermagraphy bit itchy so doc said take Allegra. doc said I may get more hives due to dermagraphy 7 - 10 days after my 3/25 shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Survey response — day 28, dose 1
MedDRA: Contusion, Office visit, Rash, Urticaria — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: More easy bruise and ekemysos occur. Unsure if reported last time had hives on nose 4 several days. doc told me rash etc might occur after shot since have dermagraphy. · Healthcare visit (other): Did blood test check platelets to confirm no clots as go 2nd shot this Sunday 4/25.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Report sent to call center — day 28, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-25
Dose 2 — Moderna
2021-04-30
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased, Hyperhidrosis, Peripheral swelling — Feeling: Good · Fever

Free text: Even before shot no.2 I sometimes awake on morn with what feels like fast heart rate and swearing which occurred last nite at 6:30 am, took blood pressure was 137/80 high for sleeping so wonder if more sweaty than usual related to gettin 2nd vaccine shot last Sunday. Also riight calf seemed swolllen yesterday like something hard inside.. today calf is more flexible.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-01
Survey response — days 1–6 daily, dose 2
MedDRA: Electric shock sensation — Feeling: Good

Free text: Had few electric twinges in my ankle where have a rod implant.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Survey response — day 7, dose 2
MedDRA: Induration, Peripheral swelling, Skin abrasion — Feeling: Good

Free text: Today and last Friday saw my right calf in back seems a bit swollen and bit hard but this morn was softer and now bit harder again at 11:15 pm. Also abrasion got early feb. still not healed 100 percent

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Survey response — day 14, dose 2
MedDRA: Back pain, Condition aggravated, Eructation, Flatulence, Heart rate increased, Pain, Pre-existing disease — Feeling: Good

Free text: More burping and gas than usual and sometimes feel like fast heart rate but when checked it Was Im. Had issues before but seemed bit worse now 2 wks since 2nd shot. Back pain also seems worse. Heart rate ok when I checked it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Survey response — day 21, dose 2
MedDRA: Back pain, Eructation, Gastrooesophageal reflux disease, Heart rate increased, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Burping which I get with Gerd more frequent on some days since 2nd Covid shot. Also more back pain than usual and what I perceived as fast heart rate but when checked blood pressure within normal range, · Healthcare visit (other): Mentioned Gerd burping etc in follow up visithhto digestive doc last week during follow up ap

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-27
Survey response — day 28, dose 2
MedDRA: Peripheral swelling — Feeling: Good

Free text: Thought back of left leg and right hand swollen more than usual.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-01
Survey response — day 35, dose 2
MedDRA: Back pain, Memory impairment, Peripheral swelling, Pre-existing disease — Feeling: Good

Free text: Seem much more forgetful than last few weeks Although I do take a Statin 4 plaque. ..? finger puffiness more than usual. More back aches:

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-07
Survey response — day 42, dose 2
MedDRA: Hypertension, Pre-existing disease, Rash, Rash erythematous — Feeling: Good

Free text: Red rash right toe unsure if from new toe cushion used or reaction unto shot. However did notice seem to have more pulse readings in 50s than I did before upon rising in morn. Unsure if due to better blood pressure control or something else.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2022-04-11
Call 1 — Left Voicemail
2022-04-27
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-05-18
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-24	Moderna
2	2021-04-25	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-04-23	Successful	Does not wish to fill out VAERS report
2021-05-16	Successful 2022-05-18	Does not wish to fill out VAERS report

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-25

Systemic reaction (other): Felt like racy heart beat after dinner yesterday and today now near mid nite. Had these symptoms before moderna but feel like more pronounced now after get shot yesterday.

2021-03-28

Systemic reaction (other): Will take Tylenol 4 symptoms above as very mild and may also be due back problem.

2021-03-30

Systemic reaction (other): More gas today than usual all day long. Had it also 2 days ago but Seems worse today

Release 6 — day 7, dose 1

2021-04-01

Systemic reaction (other): Forgot 2 say 3 days after had shot on 3/24 I had more of rash on my nose when took hit shower. Had very mild case of dermagraphia before got shot w. Hives on nose and my Doc said I might get more hives after shot since vaccine heightens immune response which I did. Took Allegra OTC which my Docs been treating me with even before shot and it lasted less than a day. Reappears than disappears after few hours. Sorry forgot mention earlier as had more nose hives or 2 days but Doc said might occur since had detmagraphia even before vaccine.

Release 7 — day 14, dose 1

2021-04-07

Symptoms: Bit achy today & yesterday. Took 2 Tylenol and feelMore tired this eve. More rash lines on my chest which I get from my dermagraphy bit itchy so doc said take Allegra. doc said I may get more hives due to dermagraphy 7 - 10 days after my 3/25 shot. cut off by CDC

Release 7 — day 28, dose 1

2021-04-23

Symptoms: More easy bruise and ekemysos occur. Unsure if reported last time had hives on nose 4 several days. doc told me rash etc might occur after shot since have dermagraphy.

Healthcare visit (other): Did blood test check platelets to confirm no clots as go 2nd shot this Sunday 4/25.

Release 8 — days 1–6 daily, dose 2

2021-04-30

Systemic reaction (other): Even before shot no.2 I sometimes awake on morn with what feels like fast heart rate and swearing which occurred last nite at 6:30 am, took blood pressure was 137/80 high for sleeping so wonder if more sweaty than usual related to gettin 2nd vaccine shot last Sunday. Also riight calf seemed swolllen yesterday like something hard inside.. today calf is more flexible.

2021-05-01

Systemic reaction (other): Had few electric twinges in my ankle where have a rod implant.

Release 8 — day 7, dose 2

2021-05-02

Systemic reaction (other): Today and last Friday saw my right calf in back seems a bit swollen and bit hard but this morn was softer and now bit harder again at 11:15 pm. Also abrasion got early feb. still not healed 100 percent

Release 8 — day 14, dose 2

2021-05-10

Symptoms: More burping and gas than usual and sometimes feel like fast heart rate but when checked it Was Im. Had issues before but seemed bit worse now 2 wks since 2nd shot. Back pain also seems worse. Heart rate ok when I checked it.

Release 8 — day 21, dose 2

2021-05-16

Symptoms: Burping which I get with Gerd more frequent on some days since 2nd Covid shot. Also more back pain than usual and what I perceived as fast heart rate but when checked blood pressure within normal range,

Healthcare visit (other): Mentioned Gerd burping etc in follow up visithhto digestive doc last week during follow up ap

Release 8 — day 28, dose 2

2021-05-27

Symptoms: Thought back of left leg and right hand swollen more than usual.

Release 8 — day 35, dose 2

2021-06-01

Symptoms: Seem much more forgetful than last few weeks Although I do take a Statin 4 plaque. ..? finger puffiness more than usual. More back aches:

Release 8 — day 42, dose 2

2021-06-07

Symptoms: Red rash right toe unsure if from new toe cushion used or reaction unto shot. However did notice seem to have more pulse readings in 50s than I did before upon rising in morn. Unsure if due to better blood pressure control or something else.

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	Eructation	✓	✓	✓
HCVO	Gastrooesophageal reflux disease	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Contusion	✓	✓	✓
SD	Eructation	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Flatulence	✓	✓	✓
SD	Gastrooesophageal reflux disease	✓	✓	✓
SD	Heart rate increased	✓	✓	✓
SD	Hypertension	✓	✓	○
SD	Memory impairment	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash erythematous	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SD	Urticaria	✓	✓	✓
SRO	Back disorder	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Electric shock sensation	✓	✓	✓
SRO	Flatulence	✓	✓	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Induration	✓	✓	✓
SRO	Medical counselling	✓	✓	✓
SRO	Palpitations	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Skin abrasion	✓	✓	✓

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