Y64-18058-73409

2 vaccinations 10 coded responses 24 check-ins 10 free-text entries 1 call case

Sex: Female
Age at first dose: 56-60
ZIP prefix: 625 / IL
Registered: 2021-08-06

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-08-06
Registered in v-safe
2021-08-06
Dose 1 — Moderna
2021-08-06
Health check-in — day 0, dose 1
Feeling: Good · Headache

Adult check-in
2021-08-07
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-08-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · None

Adult check-in
2021-08-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-08-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-08-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-08-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-08-13
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-08-20
Survey response — day 14, dose 1
MedDRA: Injection site pruritus, Injection site swelling — Feeling: Good

Free text: Slight swelling and itching of the injection site.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-27
Survey response — day 21, dose 1
MedDRA: Rash — Feeling: Good

Free text: Slight rash on several areas of my body.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-03
Dose 2 — Moderna
2021-09-03
Survey response — day 0, dose 2
MedDRA: Medical observation, Pruritus, Self-medication — Feeling: Fair · Site: Swelling, Itching · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional

Free text: I took benadryl when the itching started and remained under observation at the clinic that administered the 2nd dose. My epi-pen was not needed.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-03
Report sent to call center — day 0, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-09-05
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good · Site: Swelling · Fatigue or tiredness

Free text: Lymph node swelling on the same side as the injection.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-06
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: supraclavicular lymphadenopathy on side of injection

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-07
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good

Free text: supraclavicular lymphadenopathy

MedDRA releases: 2024-11 · check-in free text available
2021-09-08
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good · Joint pains

Free text: supraclavicular lymphadenopathy

MedDRA releases: 2024-11 · check-in free text available
2021-09-09
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good

Free text: supraclavicular lymphadenopathy

MedDRA releases: 2024-11 · check-in free text available
2021-09-10
Survey response — day 7, dose 2
MedDRA: Lymphadenopathy — Feeling: Good

Free text: supraclavicular lymphadenopathy still present on the side of the injection

MedDRA releases: 2024-11 · check-in free text available
2021-09-13
Call 1 — Left Voicemail
2021-09-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-09-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-10-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-10-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-10-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-12-03
Survey response — 3 months, dose 2
MedDRA: Bronchitis, Influenza like illness, Self-medication — Feeling: Fair

Free text: Flu like symptoms with bronchitis. I have been treating the symptoms with OTC medication and increased fluid intake.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-08-06	Moderna	No
2	2021-09-03	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-03	Unsuccessful

Free text

Release 9 — day 14, dose 1

2021-08-20

Symptoms: Slight swelling and itching of the injection site.

Release 9 — day 21, dose 1

2021-08-27

Symptoms: Slight rash on several areas of my body.

Release 9 — day 0, dose 2

2021-09-03

Healthcare visit (other): I took benadryl when the itching started and remained under observation at the clinic that administered the 2nd dose. My epi-pen was not needed.

Release 9 — days 1–6 daily, dose 2

2021-09-05

Systemic reaction (other): Lymph node swelling on the same side as the injection.

2021-09-06

Systemic reaction (other): supraclavicular lymphadenopathy on side of injection

2021-09-07

Systemic reaction (other): supraclavicular lymphadenopathy

2021-09-08

Systemic reaction (other): supraclavicular lymphadenopathy

2021-09-09

Systemic reaction (other): supraclavicular lymphadenopathy

Release 9 — day 7, dose 2

2021-09-10

Systemic reaction (other): supraclavicular lymphadenopathy still present on the side of the injection

Release 10 — 3 months, dose 2

2021-12-03

Symptoms: Flu like symptoms with bronchitis. I have been treating the symptoms with OTC medication and increased fluid intake.

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	Pruritus	✓	·	✓
HCVO	Self-medication	✓	·	✓
SD	Bronchitis	·	·	✓
SD	Influenza like illness	·	·	✓
SD	Injection site pruritus	✓	·	✓
SD	Injection site swelling	✓	·	✓
SD	Rash	✓	·	✓
SD	Self-medication	·	·	✓
SRO	Lymphadenopathy	✓	·	✓

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