YXB-27771-98012

2 vaccinations 7 coded responses 19 check-ins 7 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 600 / IL
Registered: 2021-02-22

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

2021-02-12
Dose 1 — Moderna
2021-02-22
Registered in v-safe
2021-02-22
Survey response — day 7, dose 1
MedDRA: Confusional state, Peripheral swelling — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Legs are more swollen than usual. Increased confusion.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Survey response — day 14, dose 1
MedDRA: Fatigue — Feeling: Good · Be unable to do your normal daily activities

Free text: Increased fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-12
Dose 2 — Moderna
2021-03-12
Health check-in — day 0, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling · Fatigue or tiredness

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Office visit — Feeling: Fair · Joint pains, 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 · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): 3 x 2 bump with a sore by my elbow which is painful. I also gave a 5 x 4 blister and small blisters on my lower leg. · Healthcare visit (other): Going to see the doctor in person tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Survey response — day 7, dose 2
MedDRA: Erythema, Office visit, Pemphigoid, Peripheral swelling — Feeling: Fair · Joint pains · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Huge Bulbous Pemphigoid blisters on both lower legs - never had these before, diagnosed todayThumb is red and swollen. · Healthcare visit (other): Went to my doctors office.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Report sent to call center — day 7, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-26
Survey response — day 14, dose 2
MedDRA: Blister, Lymphoedema, Medical counselling — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Lymphedema and giant blisters on both lower legs. Saw 2 doctors. Doppler test was negative for blood clots. Diagnosed with Bullous Lymphedema. Topical and oral antibiotics were prescribed.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-02
Survey response — day 21, dose 2
MedDRA: Blister, Pain, Peripheral swelling, Skin erosion — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: My legs swelled more and the huge blisters on my legs got worse. The skin is raw. Im in severe pain Im on oral and topical antibiotics. Again, the swelling started after the first Moderna vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-09
Health check-in — day 28, dose 2
Feeling: Poor

Adult check-in
2021-04-16
Health check-in — day 35, dose 2
Feeling: Poor

Adult check-in
2021-04-25
Health check-in — day 42, dose 2
Feeling: Poor

Adult check-in
2021-06-11
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-06-11
Call 1 — Left Voicemail
2021-06-11
Call 1 — Left Voicemail
2021-06-11
Call 1 — Left Voicemail
2021-06-11
Call 1 — Left Voicemail
2021-09-11
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-03-12
Survey response — 12 months, dose 2
MedDRA: Blister, Medical counselling, Peripheral swelling, Pulmonary oedema, Skin injury, Vaccine positive rechallenge — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: After the Moderna booster my legs swelled and blistered and I had fluid in my lungs. Just like the first and second vaccine. The blisters damaged my skin. · Healthcare visit (other): Home visiting nurse.

MedDRA releases: 2024-11 · check-in free text available
2022-03-12
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-03-15
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-12	Moderna
2	2021-03-12	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-18	Successful	Participant prefers to complete VAERS report online
2021-03-19	Successful	Participant prefers to complete VAERS report online
2021-03-26	Successful	Participant prefers to complete VAERS report online
2021-04-02	Successful	Participant prefers to complete VAERS report online
2022-03-12	Successful 2022-03-15	Participant prefers to complete VAERS report online

Free text

Release 4 — day 7, dose 1

2021-02-22

Systemic reaction (other): Legs are more swollen than usual. Increased confusion.

Release 4 — day 14, dose 1

2021-02-26

Symptoms: Increased fatigue.

Release 5 — days 1–6 daily, dose 2

2021-03-18

Systemic reaction (other): 3 x 2 bump with a sore by my elbow which is painful. I also gave a 5 x 4 blister and small blisters on my lower leg.

Healthcare visit (other): Going to see the doctor in person tomorrow

Release 6 — day 7, dose 2

2021-03-19

Systemic reaction (other): Huge Bulbous Pemphigoid blisters on both lower legs - never had these before, diagnosed todayThumb is red and swollen.

Healthcare visit (other): Went to my doctors office.

Release 6 — day 14, dose 2

2021-03-26

Symptoms: Lymphedema and giant blisters on both lower legs. Saw 2 doctors. Doppler test was negative for blood clots. Diagnosed with Bullous Lymphedema. Topical and oral antibiotics were prescribed.

Release 6 — day 21, dose 2

2021-04-02

Symptoms: My legs swelled more and the huge blisters on my legs got worse. The skin is raw. Im in severe pain Im on oral and topical antibiotics. Again, the swelling started after the first Moderna vaccine.

Release 11 — 12 months, dose 2

2022-03-12

Symptoms: After the Moderna booster my legs swelled and blistered and I had fluid in my lungs. Just like the first and second vaccine. The blisters damaged my skin.

Healthcare visit (other): Home visiting nurse.

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	Medical counselling	·	·	✓
HCVO	Office visit	✓	✓	✓
SD	Blister	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Lymphoedema	✓	✓	✓
SD	Medical counselling	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pulmonary oedema	·	·	✓
SD	Skin erosion	✓	✓	✓
SD	Skin injury	·	·	✓
SD	Vaccine positive rechallenge	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Confusional state	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Pemphigoid	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓

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