YDS-14239-04004

3 vaccinations 12 coded responses 14 check-ins 12 free-text entries 3 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 044 / ME
Registered: 2021-02-17

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

2021-02-17
Registered in v-safe
2021-02-17
Dose 1 — Moderna
2021-03-03
Survey response — day 14, dose 1
MedDRA: Rash pruritic — Feeling: Good

Free text: sporadically small itchy bumps

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — day 21, dose 1
MedDRA: Rash — Feeling: Good

Free text: Still having sporadic (smaller) chicken pox like rash on legs, arms, back, scalp, neck, etc but not all at once and it appears to be lessening.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Dose 2 — Moderna
2021-03-17
Survey response — day 0, dose 2
MedDRA: Rash vesicular — Feeling: Good · Site: Pain, Swelling · Chills, Rash, not including the immediate area around the injection site

Free text: Still have a slight Chicken pox like rash from first shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — days 1–6 daily, dose 2
MedDRA: Rash, Rash vesicular — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Rash is chicken pox like and residual from the first shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — days 1–6 daily, dose 2
MedDRA: Rash, Vaccine positive rechallenge — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site

Free text: Chicken pox like rash. Continuation from first shot with new spots since second shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-04-03
Survey response — day 14, dose 2
MedDRA: Nausea, Pain, Pyrexia, Rash — Feeling: Good

Free text: Within two days of having the second vaccine the rash worsened. Mostly at base of my scalp & near my spine in my mid back. Yesterday 5min pain in my mid R side radiated around to front. Doubled over, felt nauseous, had a low grade temp 2hrs.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Survey response — day 21, dose 2
MedDRA: Rash, Rash pruritic — Feeling: Good

Free text: Still have the chicken pox like rash but mainly along my spine and back scalp area. Itchy bumps on top of bumps now.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Survey response — day 28, dose 2
MedDRA: Rash — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: My chicken pox like rash has worsened and is spreading on the back of my scalp. It still remains on the right side of my spine mid back. I have an appointment with at my drs office tomorrow.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-22
Survey response — day 35, dose 2
MedDRA: Office visit, Rash — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Still have chicken pox like rash on back of scalp and right of mid spine. Lessening on spine and more to the left of the back of scalp. · Healthcare visit (other): My doctors clinic

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-28
Survey response — day 42, dose 2
MedDRA: Rash, Rash pruritic — Feeling: Good

Free text: Still have itchy chicken pox like rash on back of scalp and right of mid spine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-16
Survey response — 6 months, dose 2
MedDRA: Office visit, Rash, Rash morbilliform — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Still have measle like rash on back and back of scalp. Sometimes it appears on abdomen, arms, and legs. · Healthcare visit (other): Primary care

MedDRA releases: 2024-11 · check-in free text available
2021-09-16
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-17
Call 1 — Left Voicemail
2021-09-17
Call successful
Participant prefers to complete VAERS report online
2021-12-15
Dose 3 — Moderna
2022-03-17
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-03-17
Survey response — 3 months, dose 3
MedDRA: Pyrexia, Rash morbilliform, Surgery, Upper limb fracture — Feeling: Good

Free text: After 3rd dose, slight fever & measle like rash but it didn't last long. I was recovering from elbow fracture surgery. I noticed after I fractured my arm on October 26, 2021 my sproradic measle like rash (since 1st dose) pretty much disappeared.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-17	Moderna
2	2021-03-17	Moderna
3	2021-12-15	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-19	Successful	Participant prefers to complete VAERS report online
2021-04-22	Successful	Participant prefers to complete VAERS report online
2021-09-16	Successful 2021-09-17	Participant prefers to complete VAERS report online

Free text

Release 5 — day 14, dose 1

2021-03-03

Symptoms: sporadically small itchy bumps

Release 5 — day 21, dose 1

2021-03-10

Symptoms: Still having sporadic (smaller) chicken pox like rash on legs, arms, back, scalp, neck, etc but not all at once and it appears to be lessening.

Release 5 — day 0, dose 2

2021-03-17

Systemic reaction (other): Still have a slight Chicken pox like rash from first shot.

Release 5 — days 1–6 daily, dose 2

2021-03-18

Systemic reaction (other): Rash is chicken pox like and residual from the first shot.

2021-03-19

Systemic reaction (other): Chicken pox like rash. Continuation from first shot with new spots since second shot.

Release 6 — day 14, dose 2

2021-04-03

Symptoms: Within two days of having the second vaccine the rash worsened. Mostly at base of my scalp & near my spine in my mid back. Yesterday 5min pain in my mid R side radiated around to front. Doubled over, felt nauseous, had a low grade temp 2hrs.

Release 7 — day 21, dose 2

2021-04-09

Symptoms: Still have the chicken pox like rash but mainly along my spine and back scalp area. Itchy bumps on top of bumps now.

Release 7 — day 28, dose 2

2021-04-19

Symptoms: My chicken pox like rash has worsened and is spreading on the back of my scalp. It still remains on the right side of my spine mid back. I have an appointment with at my drs office tomorrow.

Release 7 — day 35, dose 2

2021-04-22

Symptoms: Still have chicken pox like rash on back of scalp and right of mid spine. Lessening on spine and more to the left of the back of scalp.

Healthcare visit (other): My doctors clinic

Release 8 — day 42, dose 2

2021-04-28

Symptoms: Still have itchy chicken pox like rash on back of scalp and right of mid spine.

Release 9 — 6 months, dose 2

2021-09-16

Symptoms: Still have measle like rash on back and back of scalp. Sometimes it appears on abdomen, arms, and legs.

Healthcare visit (other): Primary care

Release 11 — 3 months, dose 3

2022-03-17

Symptoms: After 3rd dose, slight fever & measle like rash but it didn't last long. I was recovering from elbow fracture surgery. I noticed after I fractured my arm on October 26, 2021 my sproradic measle like rash (since 1st dose) pretty much disappeared.

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	Nausea	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash morbilliform	·	·	✓
SD	Rash pruritic	✓	✓	✓
SD	Surgery	·	·	✓
SD	Upper limb fracture	·	·	✓
SRO	Rash	✓	✓	✓
SRO	Rash vesicular	✓	✓	✓
SRO	Vaccine positive rechallenge	✓	✓	✓

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