ZAM-12593-00148
2 vaccinations
3 coded responses
18 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 087 / NJ
- Registered
- 2021-01-31
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-21
Dose 1 — Moderna
-
2021-01-31
Registered in v-safe
-
2021-01-31
Health check-in — day 7, dose 1Feeling: Good · Site: Pain, Redness, Swelling, Itching · NoneAdult check-in
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2021-02-04
Survey response — day 14, dose 1MedDRA: Office visit, Pain in extremity, Pruritus, Rash — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: The rash that I have on my arm got larger since the check in I had with you last week. It is very itchy and hurts. I have been to my family doctor and to the dermatologist. I have been putting ice And using different creams. It has been seven days. · Healthcare visit (other): Dr officeMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-04
Report sent to call center — day 14, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-02-11
- 2021-02-18
-
2021-02-23
Dose 2 — Moderna
-
2021-02-25
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Redness, Swelling, Itching · NoneAdult check-in
-
2021-02-26
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness, Swelling, Itching · NoneAdult check-in
-
2021-02-27
Survey response — days 1–6 daily, dose 2MedDRA: Rash — Feeling: Fair · Site: Pain, Redness, Swelling, ItchingFree text: I would like to speak to someday about having the rash each time after my vaccinationsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-28
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia, Injection site rash — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint painsFree text: The rash has now gone down my arm to my elbow pain in my elbow. The first time I had the rash it did now go down to my elbow.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-01
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness, Itching · NoneAdult check-in
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
- 2021-04-06
- 2021-05-27
-
2021-06-30
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-08-24
- 2022-02-23
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-21 | Moderna | |
| 2 | 2021-02-23 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-02-04 | Successful 2021-06-30 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 3 — day 14, dose 1
Symptoms: The rash that I have on my arm got larger since the check in I had with you last week. It is very itchy and hurts. I have been to my family doctor and to the dermatologist. I have been putting ice And using different creams. It has been seven days. cut off by CDC
Healthcare visit (other): Dr office
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): I would like to speak to someday about having the rash each time after my vaccinations
Systemic reaction (other): The rash has now gone down my arm to my elbow pain in my elbow. The first time I had the rash it did now go down to my elbow.
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 | Office visit | ✓ | ✓ | ✓ |
| SD | Pain in extremity | ✓ | ✓ | ✓ |
| SD | Pruritus | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Injection site rash | ✓ | ✓ | ✓ |
| SRO | Rash | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release