YZ5-20387-59412
4 vaccinations
5 coded responses
55 check-ins
4 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 088 / NJ
- Registered
- 2021-02-27
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-27
Registered in v-safe
-
2021-02-27
Dose 1 — Moderna
-
2021-02-27
Survey response — day 0, dose 1MedDRA: Unevaluable event — Feeling: Good · Site: SwellingFree text: I just received the vaccine at 1 pm todayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-05
- 2021-03-06
- 2021-03-13
- 2021-03-20
-
2021-03-27
Dose 2 — Moderna
- 2021-03-27
-
2021-03-28
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness, NauseaAdult check-in
- 2021-03-29
- 2021-03-30
- 2021-03-31
-
2021-04-01
Survey response — days 1–6 daily, dose 2MedDRA: Rash, Rash erythematous, Rash pruritic — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: The rash was on the inside of my arms, tiny red dots that were itchy. It went way after a half hour.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-02
- 2021-04-03
- 2021-04-10
- 2021-04-17
- 2021-04-24
- 2021-05-01
- 2021-05-08
- 2021-06-26
- 2021-09-25
-
2021-11-18
Dose 3 — Moderna
- 2021-11-18
-
2021-11-19
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain, Redness · Chills, Headache, Joint pains, Fatigue or tiredness, NauseaAdult check-in
-
2021-11-20
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Redness · Fatigue or tirednessAdult check-in
-
2021-11-21
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Itching · Fatigue or tirednessAdult check-in
- 2021-11-22
- 2021-11-23
- 2021-11-24
- 2021-11-25
- 2021-12-02
- 2021-12-09
- 2021-12-16
- 2021-12-23
- 2021-12-30
-
2022-02-17
Survey response — 3 months, dose 3MedDRA: Diverticulitis, Office visit, Rash, Rash pruritic — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Symptoms: Diverticulitis (Iam still getting the rash that itches at strange times on the inside of my forearms it goes away after about 10 minutes) · Healthcare visit (other): Followup blood work, visit to primary care physician, gastroenterologist wilk be getting a colonoscopy next weekMedDRA releases: 2024-11 · check-in free text available
-
2022-02-17
Report sent to call center — 3 months, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prEmergency room or emergency department visit · 1 call case(s)
- 2022-02-22
-
2022-02-24
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-04-22
Dose 4 — Moderna
- 2022-04-22
-
2022-04-23
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Chills, HeadacheAdult check-in
- 2022-04-24
- 2022-04-25
- 2022-04-26
- 2022-04-27
- 2022-04-28
-
2022-04-29
Health check-in — day 7, dose 4Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
- 2022-05-06
- 2022-05-13
- 2022-05-20
- 2022-05-27
- 2022-06-03
- 2022-07-22
-
2022-10-23
Survey response — 6 months, dose 4MedDRA: Blood bilirubin increased, Infection, Office visit, Rash pruritic, Vitamin B12 deficiency — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: At my annual physical Bilirubin is elevated, B12 deficiency. I am still getting the itchy rash on my since the last covid vaccine. My PCP thinks I have an infection somewhere. I will be going to Gastroenterologist in December and/or other specialist · Healthcare visit (other): In person visitMedDRA releases: 2024-11 · check-in free text available
-
2022-10-23
Report sent to call center — 6 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
- 2022-10-26
-
2023-04-22
Survey response — 12 months, dose 4MedDRA: Herpes zoster, Pain, Rash pruritic, Vitamin D decreased — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-04-22
Report sent to call center — 12 months, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2023-04-24
Call successfulCompleted over the phone
-
2023-04-24
Call successfulCompleted over the phone
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-27 | Moderna | |
| 2 | 2021-03-27 | Moderna | |
| 3 | 2021-11-18 | Moderna | No |
| 4 | 2022-04-22 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-02-17 | Successful 2022-02-24 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2022-10-23 | Successful 2023-04-24 |
Completed over the phone |
| 2023-04-22 | Successful 2023-04-24 |
Completed over the phone |
Free text
Release 4 — day 0, dose 1
Systemic reaction (other): I just received the vaccine at 1 pm today
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): The rash was on the inside of my arms, tiny red dots that were itchy. It went way after a half hour.
Release 11 — 3 months, dose 3
Symptoms: Diverticulitis (Iam still getting the rash that itches at strange times on the inside of my forearms it goes away after about 10 minutes)
Healthcare visit (other): Followup blood work, visit to primary care physician, gastroenterologist wilk be getting a colonoscopy next week
Release 12 — 6 months, dose 4
Symptoms: At my annual physical Bilirubin is elevated, B12 deficiency. I am still getting the itchy rash on my since the last covid vaccine. My PCP thinks I have an infection somewhere. I will be going to Gastroenterologist in December and/or other specialist cut off by CDC
Healthcare visit (other): In person visit
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 | Blood bilirubin increased | · | · | ✓ |
| SD | Diverticulitis | · | · | ✓ |
| SD | Herpes zoster | · | · | ✓ |
| SD | Infection | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Rash | · | · | ✓ |
| SD | Rash pruritic | · | · | ✓ |
| SD | Vitamin B12 deficiency | · | · | ✓ |
| SD | Vitamin D decreased | · | · | ✓ |
| SRO | Rash | ✓ | ✓ | ✓ |
| SRO | Rash erythematous | ✓ | ✓ | ✓ |
| SRO | Rash pruritic | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release