YF3-62411-78628

2 vaccinations 4 coded responses 21 check-ins 4 free-text entries 2 call cases

Sex: Male
Age at first dose: 46-50
ZIP prefix: 681 / NE
Registered: 2021-04-30

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

2021-04-30
Registered in v-safe
2021-04-30
Dose 1 — Moderna
2021-04-30
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-05-01
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus, Urticaria — Feeling: Fair · Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: I broken out in hives and they itch

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Rash, not including the immediate area around the injection site

Adult check-in
2021-05-03
Survey response — days 1–6 daily, dose 1
MedDRA: Malaise — Feeling: Fair · Rash, not including the immediate area around the injection site

Free text: There should be an option on how you're feeling today between good and fair cuz I don't feel fair I feel better than fair but I feel not quite myself

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-05-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Abdominal pain

Adult check-in
2021-05-07
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-05-14
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-21
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-28
Dose 2 — Moderna
2021-05-28
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-05-29
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-05-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection site

Adult check-in
2021-06-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-06-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Abdominal pain, Rash, not including the immediate area around the injection site

Adult check-in
2021-06-04
Health check-in — day 7, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-06-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-20
Survey response — day 21, dose 2
MedDRA: Blister, Urticaria — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Not enough characters to describe. Pre vaccination recurring welts have anything for me 2 days ago the wealth started manifesting is water blisters so I reached out to my doctor I don't believe it to be vaccine related

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-20
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-25
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-29
Call 1 — Could Not Reach Participant
2021-07-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-07-02
Call 2 — Could Not Reach Participant
2021-07-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-27
Survey response — 3 months, dose 2
MedDRA: Allergic reaction to excipient, Office visit, Rosacea, Urticaria — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: The world welt like hives that proliferated my arms and torso front and back went away but I developed severe rosacea. The theory is that I'm allergic to propylene glycol and that's a common ingredient in almost everything including most vaccines · Healthcare visit (other): I scheduled an appointment and went in and saw my doctor why is that not an option above?

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-27
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-30
Call 1 — Could Not Reach Participant
2021-09-01
Call 2 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-30	Moderna
2	2021-05-28	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-06-20	Unsuccessful
2021-08-27	Unsuccessful

Free text

Release 8 — days 1–6 daily, dose 1

2021-05-01

Systemic reaction (other): I broken out in hives and they itch

2021-05-03

Systemic reaction (other): There should be an option on how you're feeling today between good and fair cuz I don't feel fair I feel better than fair but I feel not quite myself

Release 9 — day 21, dose 2

2021-06-20

Symptoms: Not enough characters to describe. Pre vaccination recurring welts have anything for me 2 days ago the wealth started manifesting is water blisters so I reached out to my doctor I don't believe it to be vaccine related

Release 9 — 3 months, dose 2

2021-08-27

Symptoms: The world welt like hives that proliferated my arms and torso front and back went away but I developed severe rosacea. The theory is that I'm allergic to propylene glycol and that's a common ingredient in almost everything including most vaccines

Healthcare visit (other): I scheduled an appointment and went in and saw my doctor why is that not an option above?

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	Allergic reaction to excipient	✓	·	✓
SD	Blister	✓	✓	✓
SD	Rosacea	✓	·	✓
SD	Urticaria	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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