Z5B-18220-71796

1 vaccination 12 coded responses 16 check-ins 12 free-text entries 4 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 436 / OH
Registered: 2021-02-25

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

2021-02-25
Registered in v-safe
2021-02-25
Dose 1 — Moderna
2021-02-25
Survey response — day 0, dose 1
MedDRA: Anaphylactic reaction, Immediate post-injection reaction, Mast cell activation syndrome — Feeling: Poor · Headache, Nausea · Be unable to do your normal daily activities

Free text: 10 After vaccine developed mast cell /anaphylaxis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-02-27
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Fair

Free text: Itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Survey response — days 1–6 daily, dose 1
MedDRA: Anaphylaxis treatment, Erythema, Lip swelling, Medical observation, Swelling, Swelling face — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Turned bright red on face , arms and chest . Swelling of lips , Face and neck · Healthcare visit (other): Mother is a nurse . Administered Benadryl and Epi Pen and Resemic Epi and Albuteral breathing treatments

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
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)
2021-03-01
Survey response — days 1–6 daily, dose 1
MedDRA: Condition aggravated, Oedema, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Edema from her mast cell disease

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · None

Adult check-in
2021-03-03
Survey response — days 1–6 daily, dose 1
MedDRA: Oedema — Feeling: Fair · Be unable to do your normal daily activities

Free text: Large amount of edema from mast cell disease

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — day 7, dose 1
MedDRA: Unevaluable event — Feeling: Fair

Free text: None that are related to the shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — day 14, dose 1
MedDRA: Sinus disorder — Feeling: Good

Free text: Sinus issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — day 21, dose 1
MedDRA: Nausea, Pre-existing disease, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Nausea and vomiting from autoimmune disease

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Survey response — day 28, dose 1
MedDRA: Abdominal distension, Decreased appetite, Diarrhoea, Nausea, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Nausea, Vomiting , diarrhea, bloated stomach , loss of appetite . Unable to eat or drink for 3 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — day 35, dose 1
MedDRA: Anaphylactic reaction — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Anaphylactic teaction

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Report sent to call center — day 35, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-10
Health check-in — day 42, dose 1
Feeling: Fair

Adult check-in
2021-05-29
Survey response — 3 months, dose 1
MedDRA: Chest pain, Heart rate increased — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Chest pain snd rapid heart rate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-29
Report sent to call center — 3 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-07
Call 1 — Left Voicemail
2021-08-26
Survey response — 6 months, dose 1
MedDRA: Anaphylactic reaction, Mobility decreased, Pre-existing disease — 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: Increased anaphylactic reactions from my mast cell disease . Also decreased mobility from Ehlers Danlos disease

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-26
Report sent to call center — 6 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-31
Call 1 — Left Voicemail
2022-02-25
Health check-in — 12 months, dose 1
Feeling: Poor

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-25	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-02-28	Unsuccessful
2021-04-01	Unsuccessful
2021-05-29	Unsuccessful
2021-08-26	Unsuccessful

Free text

Release 4 — day 0, dose 1

2021-02-25

Systemic reaction (other): 10 After vaccine developed mast cell /anaphylaxis

Release 4 — days 1–6 daily, dose 1

2021-02-27

Systemic reaction (other): Itching

2021-02-28

Systemic reaction (other): Turned bright red on face , arms and chest . Swelling of lips , Face and neck

Healthcare visit (other): Mother is a nurse . Administered Benadryl and Epi Pen and Resemic Epi and Albuteral breathing treatments

2021-03-01

Systemic reaction (other): Edema from her mast cell disease

Release 5 — days 1–6 daily, dose 1

2021-03-03

Systemic reaction (other): Large amount of edema from mast cell disease

Release 5 — day 7, dose 1

2021-03-04

Systemic reaction (other): None that are related to the shot

Release 5 — day 14, dose 1

2021-03-11

Symptoms: Sinus issues

Release 5 — day 21, dose 1

2021-03-18

Symptoms: Nausea and vomiting from autoimmune disease

Release 6 — day 28, dose 1

2021-03-25

Symptoms: Nausea, Vomiting , diarrhea, bloated stomach , loss of appetite . Unable to eat or drink for 3 days

Release 6 — day 35, dose 1

2021-04-01

Symptoms: Anaphylactic teaction

Release 8 — 3 months, dose 1

2021-05-29

Symptoms: Chest pain snd rapid heart rate

Release 9 — 6 months, dose 1

2021-08-26

Symptoms: Increased anaphylactic reactions from my mast cell disease . Also decreased mobility from Ehlers Danlos disease

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	Anaphylaxis treatment	✓	✓	✓
HCVO	Medical observation	✓	✓	✓
SD	Abdominal distension	✓	✓	✓
SD	Anaphylactic reaction	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Decreased appetite	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Heart rate increased	✓	✓	✓
SD	Mobility decreased	✓	·	✓
SD	Nausea	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Sinus disorder	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Anaphylactic reaction	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Lip swelling	✓	✓	✓
SRO	Mast cell activation syndrome	✓	✓	✓
SRO	Oedema	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Swelling	✓	✓	✓
SRO	Swelling face	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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