ZDN-22250-67071

2 vaccinations 11 coded responses 24 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 303 / GA
Registered: 2021-02-17

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-02-17
Registered in v-safe
2021-02-17
Dose 1 — Moderna
2021-02-17
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-02-19
Survey response — days 1–6 daily, dose 1
MedDRA: Erythema — Feeling: Good · Site: Redness

Free text: Redness but not near the site. It was there yesterday but realized not quite where I was vaccinated.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-24
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-10
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-17
Dose 2 — Moderna
2021-03-17
Survey response — day 0, dose 2
MedDRA: Dysgeusia, Paraesthesia — Feeling: Good · Site: Pain

Free text: Tinny taste since the shot, slight tingling throughout the body after the shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-03-19
Survey response — days 1–6 daily, dose 2
MedDRA: Hypersensitivity, Injection site discolouration, Injection site pain, Injection site rash, Myalgia, Pain, Pre-existing disease, Rash, Self-medication, Unevaluable event — Feeling: Good · Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: Below where I got the shot I have muscle pain when I lift my arm and discoloration and a rash. Took 2 benadryls because of hydrochloride which I am allergic to which is in the moderna shot I read.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — days 1–6 daily, dose 2
MedDRA: Dark circles under eyes, Rash, Swelling of eyelid — Feeling: Fair · Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: Underneath my eyes are swollen and have noticeably dark circles since Wednesday night, particularly my right eye. Still have the rash and discoloration on my left arm but no longer have a rash on the right one.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Survey response — days 1–6 daily, dose 2
MedDRA: Dark circles under eyes, Eye swelling, Self-medication — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: My eyes are not as swollen as yesterday and also the dark circles under my eyes have lessen. Did take 2 more benadryls today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — days 1–6 daily, dose 2
MedDRA: Eye swelling, Rash, Skin discolouration — Feeling: Good · Headache, Rash, not including the immediate area around the injection site

Free text: Eyes still swollen but less than yesterday, right eye more s than left on. Still have a rash no itching and discoloration on left arm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Survey response — days 1–6 daily, dose 2
MedDRA: Dark circles under eyes, Eye swelling, Injection site discolouration — Feeling: Fair · Headache, Rash, not including the immediate area around the injection site

Free text: Still swollen underneath my eyes, more on the right one and slight dark circles. Still have discoloration on left arm below the shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Survey response — day 7, dose 2
MedDRA: Eye disorder, Nasopharyngitis, Rash, Rash pruritic — Feeling: Fair · Site: Itching · Fever · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Felt like I was catching a cold not sure it's from the shot. Had dental work the day before the shot. Eyes still the same as yesterday. New rash spot on left arm slightly itchy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — day 14, dose 2
MedDRA: Fatigue, Hypopnoea, Night sweats — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Started sweating at night recently and not breathing as deeply. Also tired throughout the day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-07
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-14
Survey response — day 28, dose 2
MedDRA: Eye pruritus, Eye swelling, Headache, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Itching again, eyes still swollen, tiny breakouts on face , slight headache in left eye a few times, no Tylenol nedded.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

no matching call case
2021-04-21
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-28
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-16
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-09-17
Survey response — 6 months, dose 2
MedDRA: Allergy to vaccine, Eye swelling, Fatigue — Feeling: Fair

Free text: Tire often, swollen eyes still, allergic to the moderna shot.

MedDRA releases: 2024-11 · check-in free text available
2022-01-29
Call 1 — Left Voicemail
2022-02-05
Call 2 — Left Voicemail
2022-02-07
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-17	Moderna
2	2021-03-17	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-31	Successful 2022-02-07	Does not wish to fill out VAERS report

1 report(s) with no call case — see the timeline.

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-19

Systemic reaction (other): Redness but not near the site. It was there yesterday but realized not quite where I was vaccinated.

Release 5 — day 0, dose 2

2021-03-17

Systemic reaction (other): Tinny taste since the shot, slight tingling throughout the body after the shot

Release 6 — days 1–6 daily, dose 2

2021-03-19

Systemic reaction (other): Below where I got the shot I have muscle pain when I lift my arm and discoloration and a rash. Took 2 benadryls because of hydrochloride which I am allergic to which is in the moderna shot I read.

2021-03-20

Systemic reaction (other): Underneath my eyes are swollen and have noticeably dark circles since Wednesday night, particularly my right eye. Still have the rash and discoloration on my left arm but no longer have a rash on the right one.

2021-03-21

Systemic reaction (other): My eyes are not as swollen as yesterday and also the dark circles under my eyes have lessen. Did take 2 more benadryls today.

2021-03-22

Systemic reaction (other): Eyes still swollen but less than yesterday, right eye more s than left on. Still have a rash no itching and discoloration on left arm.

2021-03-23

Systemic reaction (other): Still swollen underneath my eyes, more on the right one and slight dark circles. Still have discoloration on left arm below the shot.

Release 6 — day 7, dose 2

2021-03-24

Systemic reaction (other): Felt like I was catching a cold not sure it's from the shot. Had dental work the day before the shot. Eyes still the same as yesterday. New rash spot on left arm slightly itchy.

Release 6 — day 14, dose 2

2021-03-31

Symptoms: Started sweating at night recently and not breathing as deeply. Also tired throughout the day.

Release 7 — day 28, dose 2

2021-04-14

Symptoms: Itching again, eyes still swollen, tiny breakouts on face , slight headache in left eye a few times, no Tylenol nedded.

Release 9 — 6 months, dose 2

2021-09-17

Symptoms: Tire often, swollen eyes still, allergic to the moderna shot.

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
SD	Allergy to vaccine	·	·	✓
SD	Eye pruritus	✓	✓	✓
SD	Eye swelling	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypopnoea	✓	✓	✓
SD	Night sweats	✓	✓	✓
SD	Rash	✓	✓	✓
SRO	Dark circles under eyes	✓	✓	✓
SRO	Dysgeusia	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Eye disorder	✓	✓	✓
SRO	Eye swelling	✓	✓	✓
SRO	Hypersensitivity	○	✓	○
SRO	Injection site discolouration	✓	✓	✓
SRO	Injection site pain	✓	·	✓
SRO	Injection site rash	✓	·	✓
SRO	Myalgia	○	✓	○
SRO	Nasopharyngitis	✓	✓	✓
SRO	Pain	✓	·	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Pre-existing disease	✓	·	✓
SRO	Rash	✓	✓	✓
SRO	Rash pruritic	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Skin discolouration	✓	✓	✓
SRO	Swelling of eyelid	✓	✓	✓
SRO	Unevaluable event	○	✓	○

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