Z3B-23941-27493
4 vaccinations
7 coded responses
51 check-ins
5 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 154 / PA
- Registered
- 2021-01-21
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-21
Registered in v-safe
-
2021-01-28
Dose 1 — Moderna
-
2021-01-28
Health check-in — day 0, dose 1Feeling: Good · Site: Pain, Swelling · Fatigue or tirednessAdult check-in
- 2021-01-29
- 2021-01-30
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-04
- 2021-02-11
-
2021-02-18
Survey response — day 21, dose 1MedDRA: Rash, Rash pruritic — Feeling: GoodFree text: A rash with itching, On my arms. Also have itching on some areas of my body with out a rash.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-25
Dose 2 — Moderna
- 2021-02-25
- 2021-02-26
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-11
- 2021-03-18
- 2021-03-25
- 2021-04-01
-
2021-04-09
Survey response — day 42, dose 2MedDRA: Pruritus, Rash pruritic — Feeling: GoodFree text: Delayed itching rash occurrence again. All over body itching with area's of raised rash thar erupt and take awhile for the eruptions to heal. A lot more on my scalp this time.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-28
Survey response — 3 months, dose 2MedDRA: Rash — Feeling: GoodFree text: The area where i got the reoccurring rash comes back every so often. I place 2 seperate side affects case through the app on the v-safe site.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-12-29
Dose 3 — ModernaCo-administered: Flu
- 2021-12-30
- 2021-12-31
- 2022-01-01
-
2022-01-02
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Swelling, Itching · NoneAdult check-in
- 2022-01-03
- 2022-01-04
- 2022-01-06
- 2022-01-12
- 2022-01-20
- 2022-01-26
- 2022-02-02
- 2022-02-09
- 2022-04-02
- 2022-07-01
-
2022-11-04
Dose 4 — ModernaCo-administered: Flu
- 2022-11-06
- 2022-11-07
- 2022-11-08
- 2022-11-09
- 2022-11-10
-
2022-11-11
Survey response — day 7, dose 4MedDRA: Unevaluable event — Feeling: Good · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: These symptoms are from a perscription medication that had really bad side-effectsMedDRA releases: 2024-11 · check-in free text available
- 2022-11-19
- 2022-11-28
-
2022-12-03
Survey response — day 28, dose 4MedDRA: Hypoaesthesia, Pain in extremity — Feeling: Good · Be unable to do your normal daily activitiesFree text: Sharp pains and now ache type pains feels like its on top of skin but is not. In lower legs and feet. There is also numbness as well. I don't think this is vaccine related i believe this is a possible new added problem concerning my back.MedDRA releases: 2024-11 · check-in free text available
- 2022-12-11
- 2022-12-17
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2023-02-05
Survey response — 3 months, dose 4MedDRA: Dizziness, Fall, Foot fracture, Headache, Office visit — 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 · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
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2023-02-05
Report sent to call center — 3 months, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
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2023-02-06
Call successfulNot applicable - Accidental Reporting
-
2023-05-05
Survey response — 6 months, dose 4MedDRA: Hypertension, Office visit — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalMedDRA releases: 2024-11
-
2023-05-05
Report sent to call center — 6 months, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
- 2023-05-09
- 2023-05-12
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-28 | Moderna | |
| 2 | 2021-02-25 | Moderna | |
| 3 | 2021-12-29 | Moderna | Flu |
| 4 | 2022-11-04 | Moderna | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2023-02-05 | Successful 2023-02-06 |
Not applicable - Accidental Reporting |
| 2023-05-05 | Unsuccessful |
Free text
Release 4 — day 21, dose 1
Symptoms: A rash with itching, On my arms. Also have itching on some areas of my body with out a rash.
Release 7 — day 42, dose 2
Symptoms: Delayed itching rash occurrence again. All over body itching with area's of raised rash thar erupt and take awhile for the eruptions to heal. A lot more on my scalp this time.
Release 8 — 3 months, dose 2
Symptoms: The area where i got the reoccurring rash comes back every so often. I place 2 seperate side affects case through the app on the v-safe site.
Release 12 — day 7, dose 4
Systemic reaction (other): These symptoms are from a perscription medication that had really bad side-effects
Release 12 — day 28, dose 4
Symptoms: Sharp pains and now ache type pains feels like its on top of skin but is not. In lower legs and feet. There is also numbness as well. I don't think this is vaccine related i believe this is a possible new added problem concerning my back.
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 | Dizziness | · | · | ✓ |
| SD | Fall | · | · | ✓ |
| SD | Foot fracture | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Hypertension | · | · | ✓ |
| SD | Hypoaesthesia | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Pruritus | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SD | Rash pruritic | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release