YMU-24791-27965

1 vaccination 6 coded responses 14 check-ins 6 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 070 / NJ
Registered: 2021-02-05

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

2021-02-04
Dose 1 — Moderna
2021-02-05
Registered in v-safe
2021-02-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-07
Survey response — days 1–6 daily, dose 1
MedDRA: Ear discomfort, Ear pain, Gingival pain, No adverse event, Oral pain, Skin ulcer, Unevaluable event — Feeling: Fair · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Having issues; but suspect that are not related to the vaccine. Left side of my face have ear ache, sore mouth and gums and two sores above my ear at the hairline. · Healthcare visit (other): Due to weekend & snow will try and make appt. tomorrow with dentist or ENT.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Ear pain, Gingival pain, Glossitis, Lip blister, Office visit, Rash — Feeling: Fair · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional

Free text: Saw dentist. Gums very sore and blisters on my lower lip Tongue irritated. Seeing ear doctor tomorrow because of pain in my ear. Also want to make sure the rash on the side of my face has not entered the ear canal, Seeing dermatologist on Thursday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Ear pain, External ear pain, Herpes zoster, Lip blister, Lip swelling, Lymphadenopathy, Medical observation, Odynophagia, Office visit, Oral pain, Rash — Feeling: Poor · Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Swollen left gland swollen lips blisters on lips rash running down the side of my face smaller rash near my eye ear canal left ear canal very painful hurts when I swallow sore inside my mouth. Not a good day at all · Healthcare visit (other): In person ENT visit. Dr. put me on Methylprednisoloneisolone and valtrex. He and his associate think the shingles I now have could very well be from the vaccine. Thoight

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Ear pain, Herpes zoster, Lymphadenopathy, Office visit — Feeling: Poor · Fever · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): I developed a severe case of shingles after receiving the vaccine. Also have swollen left gland and pain in left ear. · Healthcare visit (other): In person with dermatologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-12
Survey response — day 7, dose 1
MedDRA: Herpes zoster, Office visit, Rash — Feeling: Poor · Fever · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Still battling the shingles. Hoping the generic Valtrex will kick in soon. The rash is near my eye and I'm very frightened about my eyesight. · Healthcare visit (other): Saw dermatologist on Wednesday. Saw my ENT on Tuesday. Consulted an infectious disease doctor today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Report sent to call center — day 7, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-18
Health check-in — day 14, dose 1
Feeling: Poor

Adult check-in
2021-02-25
Survey response — day 21, dose 1
MedDRA: Herpes zoster, Office visit, Oral pain — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Mouth so painful from the shingles that I got a few days after the vaccine, doctor has added a lidocaine solution to dull the area of my mouth. · Healthcare visit (other): In person office visits

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-04
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-03-11
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-05-08
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-07-15
Call 1 — Left Voicemail
2021-07-15
Call successful
Participant prefers to complete VAERS report online
2021-08-07
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2022-02-04
Health check-in — 12 months, dose 1
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-02-07	Successful	Participant prefers to complete VAERS report online
2021-02-08	Successful	Participant prefers to complete VAERS report online
2021-02-09	Successful	Participant prefers to complete VAERS report online
2021-02-10	Successful	Participant prefers to complete VAERS report online
2021-02-12	Successful	Participant prefers to complete VAERS report online
2021-02-25	Successful 2021-07-15	Participant prefers to complete VAERS report online

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-07

Systemic reaction (other): Having issues; but suspect that are not related to the vaccine. Left side of my face have ear ache, sore mouth and gums and two sores above my ear at the hairline.

Healthcare visit (other): Due to weekend & snow will try and make appt. tomorrow with dentist or ENT.

2021-02-08

Healthcare visit (other): Saw dentist. Gums very sore and blisters on my lower lip Tongue irritated. Seeing ear doctor tomorrow because of pain in my ear. Also want to make sure the rash on the side of my face has not entered the ear canal, Seeing dermatologist on Thursday.

2021-02-09

Systemic reaction (other): Swollen left gland swollen lips blisters on lips rash running down the side of my face smaller rash near my eye ear canal left ear canal very painful hurts when I swallow sore inside my mouth. Not a good day at all

Healthcare visit (other): In person ENT visit. Dr. put me on Methylprednisoloneisolone and valtrex. He and his associate think the shingles I now have could very well be from the vaccine. Thoight

2021-02-10

Systemic reaction (other): I developed a severe case of shingles after receiving the vaccine. Also have swollen left gland and pain in left ear.

Healthcare visit (other): In person with dermatologist.

Release 4 — day 7, dose 1

2021-02-12

Systemic reaction (other): Still battling the shingles. Hoping the generic Valtrex will kick in soon. The rash is near my eye and I'm very frightened about my eyesight.

Healthcare visit (other): Saw dermatologist on Wednesday. Saw my ENT on Tuesday. Consulted an infectious disease doctor today.

Release 4 — day 21, dose 1

2021-02-25

Symptoms: Mouth so painful from the shingles that I got a few days after the vaccine, doctor has added a lidocaine solution to dull the area of my mouth.

Healthcare visit (other): In person office visits

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	Ear pain	✓	✓	✓
HCVO	Gingival pain	✓	✓	✓
HCVO	Glossitis	✓	✓	✓
HCVO	Herpes zoster	✓	✓	✓
HCVO	Lip blister	✓	✓	✓
HCVO	Medical observation	✓	✓	○
HCVO	No adverse event	○	✓	○
HCVO	Office visit	✓	✓	✓
HCVO	Rash	✓	✓	✓
HCVO	Unevaluable event	✓	·	✓
SD	Herpes zoster	✓	✓	✓
SD	Oral pain	✓	✓	✓
SRO	Ear discomfort	○	✓	○
SRO	Ear pain	✓	✓	✓
SRO	External ear pain	·	·	✓
SRO	Gingival pain	✓	✓	✓
SRO	Herpes zoster	✓	✓	✓
SRO	Lip blister	·	·	✓
SRO	Lip swelling	✓	✓	○
SRO	Lymphadenopathy	✓	✓	✓
SRO	Odynophagia	·	·	✓
SRO	Oral pain	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Skin disorder	○	·	○
SRO	Skin laceration	○	·	○
SRO	Skin ulcer	✓	·	✓
SRO	Unevaluable event	○	✓	○

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