Y8G-57157-21092

3 vaccinations 5 coded responses 38 check-ins 5 free-text entries 1 call case

Sex: Female
Age at first dose: 41-45
ZIP prefix: 540 / WI
Registered: 2021-01-30

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

2021-01-30
Registered in v-safe
2021-01-30
Dose 1 — Moderna
2021-01-30
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness, Nausea

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Itching · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness, Itching · Headache

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — day 7, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-13
Survey response — day 14, dose 1
MedDRA: Injection site erythema, Injection site pruritus, Injection site rash, Injection site warmth — Feeling: Good

Free text: Very itchy injection site on day 8. It became a perfect circular rash (1.5), very red and warm to the touch. Less noticable on day 9 and mostly gone by day 10. Today (14) still have some itching in the area and a slight color redness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-27
Dose 2 — Moderna
2021-02-28
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 · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness, Nausea

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-06
Health check-in — day 7, dose 2
Feeling: Good · Headache

Adult check-in
2021-03-13
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-21
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-27
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-03
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-29
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-28
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-06
Dose 3 — Moderna
2021-12-07
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Armpit pain (both)

MedDRA releases: 2024-11 · check-in free text available
2021-12-08
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Armpit pain

MedDRA releases: 2024-11 · check-in free text available
2021-12-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2021-12-10
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-12-11
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Swelling, Itching · Headache

Adult check-in
2021-12-12
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-12-13
Health check-in — day 7, dose 3
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-12-20
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-27
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-03
Survey response — day 28, dose 3
MedDRA: Injection site discolouration, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I have a dark area on my skin where I received my vaccine - not a bruise, just dark area. Noticed it last week. I showed my dr. during an office visit for an unrelated issue. Dr was not concerned, but I think it's peculiar for four weeks post vax.

MedDRA releases: 2024-11 · check-in free text available
2022-01-03
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-05
Call 1 — Left Voicemail
2022-01-17
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-07
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-06
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-12-06
Survey response — 12 months, dose 3
MedDRA: COVID-19 — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Currently have Covid.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-30	Moderna
2	2021-02-27	Moderna
3	2021-12-06	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-01-03	Unsuccessful

Free text

Release 4 — day 14, dose 1

2021-02-13

Symptoms: Very itchy injection site on day 8. It became a perfect circular rash (1.5), very red and warm to the touch. Less noticable on day 9 and mostly gone by day 10. Today (14) still have some itching in the area and a slight color redness.

Release 10 — days 1–6 daily, dose 3

2021-12-07

Systemic reaction (other): Armpit pain (both)

2021-12-08

Systemic reaction (other): Armpit pain

Release 10 — day 28, dose 3

2022-01-03

Symptoms: I have a dark area on my skin where I received my vaccine - not a bruise, just dark area. Noticed it last week. I showed my dr. during an office visit for an unrelated issue. Dr was not concerned, but I think it's peculiar for four weeks post vax.

Release 12 — 12 months, dose 3

2022-12-06

Symptoms: Currently have Covid.

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	COVID-19	·	·	✓
SD	Injection site discolouration	·	·	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Injection site warmth	✓	✓	✓
SD	Office visit	·	·	✓
SRO	Axillary pain	·	·	✓

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