Y9Z-27036-96106

2 vaccinations 10 coded responses 18 check-ins 10 free-text entries 1 call case

Sex: Female
Age at first dose: 36-40
ZIP prefix: 208 / MD
Registered: 2021-03-05

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
Registered in v-safe
2021-03-05
Dose 1 — Moderna
2021-03-05
Survey response — day 0, dose 1
MedDRA: Immediate post-injection reaction, Paraesthesia — Feeling: Good · Site: Pain, Itching

Free text: Immediate nerve tingling in arm after injection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Light headed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 1
MedDRA: Hypotension — Feeling: Good · Site: Pain, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Low blood pressure yesterday afternoon into night

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Joint pains, Muscle or body aches

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

Adult check-in
2021-03-20
Survey response — day 14, dose 1
MedDRA: Immunisation reaction, Injection site erythema, Injection site pruritus, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Covid arm- red itchy spot around injection site on 14ths, 15th, 16th · Healthcare visit (other): Allergist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-26
Survey response — day 21, dose 1
MedDRA: Vaccination site pruritus — Feeling: Good

Free text: Arm started itching again at vaccine site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Dose 2 — Moderna
2021-04-02
Survey response — day 0, dose 2
MedDRA: Blood pressure decreased, Tachycardia — Feeling: Fair · Site: Itching · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Tachycardia + lower blood pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Heart rate increased — Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Pulse 40 points above norm + BP 85/54 & dizzy

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: Dizziness, Hypotension — Feeling: Fair · Site: Itching · Chills, Headache, Joint pains, Muscle or body aches, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Significant light headed/low blood pressure through last night

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Injection site pruritus — Feeling: Good · Fatigue or tiredness

Free text: Bit lightheaded. Original injection site still itches some

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-09
Survey response — day 7, dose 2
MedDRA: Injection site pruritus — Feeling: Good · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Itching is at ORIGINAL injection site not dose 2

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-10-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-29
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-05	Moderna
2	2021-04-02	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-20	Unsuccessful

Free text

Release 5 — day 0, dose 1

2021-03-05

Systemic reaction (other): Immediate nerve tingling in arm after injection

Release 5 — days 1–6 daily, dose 1

2021-03-06

Systemic reaction (other): Light headed

2021-03-07

Systemic reaction (other): Low blood pressure yesterday afternoon into night

Release 6 — day 14, dose 1

2021-03-20

Symptoms: Covid arm- red itchy spot around injection site on 14ths, 15th, 16th

Healthcare visit (other): Allergist

Release 6 — day 21, dose 1

2021-03-26

Symptoms: Arm started itching again at vaccine site

Release 6 — day 0, dose 2

2021-04-02

Systemic reaction (other): Tachycardia + lower blood pressure

Release 6 — days 1–6 daily, dose 2

2021-04-03

Systemic reaction (other): Pulse 40 points above norm + BP 85/54 & dizzy

2021-04-05

Systemic reaction (other): Significant light headed/low blood pressure through last night

Release 7 — days 1–6 daily, dose 2

2021-04-07

Systemic reaction (other): Bit lightheaded. Original injection site still itches some

Release 7 — day 7, dose 2

2021-04-09

Systemic reaction (other): Itching is at ORIGINAL injection site not dose 2

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	Office visit	✓	✓	✓
SD	Immunisation reaction	✓	✓	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Vaccination site pruritus	✓	✓	✓
SRO	Blood pressure decreased	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Hypotension	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Injection site pruritus	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Tachycardia	✓	✓	✓

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