YDG-26946-70191
5 vaccinations
8 coded responses
35 check-ins
8 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 940 / CA
- Registered
- 2021-02-03
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-03
Registered in v-safe
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2021-02-03
Dose 1 — Moderna
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-17
- 2021-02-24
-
2021-03-03
Dose 2 — Moderna
- 2021-03-03
-
2021-03-04
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches · Be unable to do your normal daily activitiesAdult check-in
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2021-03-05
Survey response — days 1–6 daily, dose 2MedDRA: Pyrexia — Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Temperature is usually 96.4, so 99.9 is like 101.9MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-06
Survey response — days 1–6 daily, dose 2MedDRA: Erythema — Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Fatigue or tirednessFree text: Redness on arm is at base of deltoid and extends about 1/2 way around the arm and about 1 1/2 inches in height. I just remembered I had a similar reaction after Zostavax. The redness and swelling was on the injection site about the size of a large silver dollar. I went to MD and requested they report it to VARES as was unusual reaction. Does Zostavax have any ingredients that are in the Moderna?MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-07
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Swelling, Itching · NoneAdult check-in
- 2021-03-08
- 2021-03-09
-
2021-03-10
Survey response — day 7, dose 2MedDRA: Erythema — Feeling: Good · Site: RednessFree text: Redness on arm is fadingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-17
Survey response — day 14, dose 2MedDRA: Injection site pruritus, Rash erythematous, Self-medication — Feeling: GoodFree text: Slight itching around injection site. Took Benadryl which controlled itching. Red rash beneath Deltoid muscle has faded.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-24
Survey response — day 21, dose 2MedDRA: Injection site erythema, Injection site pain, Injection site rash, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Very Tender to touch in center area of arm where reddened Moderna rash was located beneath the deltoid muscle. Has anyone else reported this condition??? I took a picture of original rash. Im going to see my PCP about this. · Healthcare visit (other): Scheduled for visit with PCP.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-24
Report sent to call center — day 21, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-03-31
- 2021-04-08
- 2021-04-14
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2021-06-02
Survey response — 3 months, dose 2MedDRA: Alanine aminotransferase increased, Antineutrophil cytoplasmic antibody positive, Antinuclear antibody positive — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: On 4/30/2021 ANA positive, ANA IFA titer positive, cytoplasmic pattern titer positive, slightly elevated ALT. Is it possible that in attempt to teach response to spike protein for SARS CoV 2 that mounted response to other things?MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-02
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-01
-
2021-11-05
Dose 3 — Moderna
- 2021-12-15
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2022-03-05
Survey response — 12 months, dose 2MedDRA: Burning sensation, Emergency care, Erythema, Office visit, Pruritus, Tongue disorder, Urticaria — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Symptoms: Had sudden onset of hives across forehead, behind ears, and neck. Neck was itchy, red, and had burning sensation. Back of tongue felt thick. · Healthcare visit (other): Referral to allergist; had appointment with allergist next day after ED visitMedDRA releases: 2024-11 · check-in free text available
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2022-03-05
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2022-03-08
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2022-04-14
Dose 4 — Moderna
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2022-04-27
Survey response — day 7, dose 4MedDRA: Emergency care, Hypoaesthesia, Sunscreen sensitivity, Swelling, Urticaria — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: The above occurred on 4/15 to 4/16/2022. On 4/23 developed hives facial and neck swelling; seen in ER. Probably allergic reaction to sunscreen. Now have decreased sensation across forehead to both temple area.MedDRA releases: 2024-11 · check-in free text available
- 2022-04-28
- 2022-05-05
- 2022-05-12
- 2022-05-19
- 2022-05-26
- 2022-07-14
-
2022-09-26
Dose 5 — Pfizer-BioNTech
- 2022-10-13
- 2023-04-14
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-03 | Moderna | |
| 2 | 2021-03-03 | Moderna | |
| 3 | 2021-11-05 | Moderna | No |
| 4 | 2022-04-14 | Moderna | No |
| 5 | 2022-09-26 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-03-24 | Unsuccessful | |
| 2021-06-02 | Unsuccessful | |
| 2022-03-05 | Unsuccessful |
Free text
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Temperature is usually 96.4, so 99.9 is like 101.9
Systemic reaction (other): Redness on arm is at base of deltoid and extends about 1/2 way around the arm and about 1 1/2 inches in height. I just remembered I had a similar reaction after Zostavax. The redness and swelling was on the injection site about the size of a large silver dollar. I went to MD and requested they report it to VARES as was unusual reaction. Does Zostavax have any ingredients that are in the Moderna?
Release 5 — day 7, dose 2
Systemic reaction (other): Redness on arm is fading
Release 5 — day 14, dose 2
Symptoms: Slight itching around injection site. Took Benadryl which controlled itching. Red rash beneath Deltoid muscle has faded.
Release 6 — day 21, dose 2
Symptoms: Very Tender to touch in center area of arm where reddened Moderna rash was located beneath the deltoid muscle. Has anyone else reported this condition??? I took a picture of original rash. Im going to see my PCP about this.
Healthcare visit (other): Scheduled for visit with PCP.
Release 8 — 3 months, dose 2
Symptoms: On 4/30/2021 ANA positive, ANA IFA titer positive, cytoplasmic pattern titer positive, slightly elevated ALT. Is it possible that in attempt to teach response to spike protein for SARS CoV 2 that mounted response to other things?
Release 11 — 12 months, dose 2
Symptoms: Had sudden onset of hives across forehead, behind ears, and neck. Neck was itchy, red, and had burning sensation. Back of tongue felt thick.
Healthcare visit (other): Referral to allergist; had appointment with allergist next day after ED visit
Release 11 — day 7, dose 4
Systemic reaction (other): The above occurred on 4/15 to 4/16/2022. On 4/23 developed hives facial and neck swelling; seen in ER. Probably allergic reaction to sunscreen. Now have decreased sensation across forehead to both temple area.
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 | Emergency care | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| HCVO | Unevaluable event | ✓ | ✓ | ✓ |
| SD | Alanine aminotransferase increased | ✓ | ✓ | ✓ |
| SD | Antineutrophil cytoplasmic antibody positive | ✓ | ✓ | ✓ |
| SD | Antinuclear antibody positive | ✓ | ✓ | ✓ |
| SD | Burning sensation | · | · | ✓ |
| SD | Erythema | · | · | ✓ |
| SD | Injection site erythema | ✓ | ✓ | ✓ |
| SD | Injection site pain | ✓ | ✓ | ✓ |
| SD | Injection site pruritus | ✓ | ✓ | ✓ |
| SD | Injection site rash | ✓ | ✓ | ✓ |
| SD | Pruritus | · | · | ✓ |
| SD | Rash erythematous | ✓ | ✓ | ✓ |
| SD | Self-medication | ✓ | ✓ | ✓ |
| SD | Tongue disorder | · | · | ✓ |
| SD | Urticaria | · | · | ✓ |
| SRO | Emergency care | · | · | ✓ |
| SRO | Erythema | ✓ | ✓ | ✓ |
| SRO | Hypoaesthesia | · | · | ✓ |
| SRO | Pyrexia | ✓ | ✓ | ✓ |
| SRO | Sunscreen sensitivity | · | · | ✓ |
| SRO | Swelling | · | · | ✓ |
| SRO | Urticaria | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release