ZFT-15679-51505

3 vaccinations 5 coded responses 22 check-ins 5 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 973 / OR
Registered: 2021-01-27

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

2021-01-21
Dose 1 — Moderna
2021-01-27
Registered in v-safe
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Erythema, Pain, Pruritus, Rash — Feeling: Good · Site: Pain · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: On the fifth day, I experienced rash redness pain and itching. It lasted about an hour and a half and slowly dissipated.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-28
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Survey response — day 14, dose 1
MedDRA: Chills, Rash, Rash pruritic, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: On 31 January I experienced my second possible reaction to the first vaccination. I broke out in a rash with itching and cold chills. It lasted an hour and a half to two hours · Healthcare visit (other): Just reported this second incident through my doctors portal

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-11
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-18
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-24
Dose 2 — Moderna
2021-02-24
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Pruritus, Swelling face — Feeling: Fair · Chills, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Itching on feet and joints. Swelling and redness on face, joints and feet

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-24
Survey response — day 28, dose 2
MedDRA: Erythema, Swelling — Feeling: Fair · Be unable to do your normal daily activities

Free text: This is the fourth episode of swelling and redness. It was from head to toe this time and lasted approximately two hours as did the other three episodes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-13
Call 1 — Left Voicemail
2021-05-26
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-06-29
Call 1 — Left Voicemail
2021-08-27
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-29
Dose 3 — Janssen/Johnson & Johnson
2022-02-24
Survey response — 12 months, dose 2
MedDRA: Adverse reaction, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I just want to take this opportunity to let you know that after 2 Moderno vaccinations and having 5 adverse reactions, I was advised by my physician to receive a J&J booster. I had no adverse reactions from this booster.

MedDRA releases: 2024-11 · check-in free text available
2022-02-24
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-25
Call 1 — Left Voicemail
2022-04-18
Call 2 — Left Voicemail
2022-04-19
Call 3 — Left Voicemail
2022-04-19
Call successful
Does not wish to fill out VAERS report
2022-10-29
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Moderna
2	2021-02-24	Moderna
3	2021-10-29	Janssen/Johnson & Johnson	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-27	Successful	Does not wish to fill out VAERS report
2021-02-04	Successful	Does not wish to fill out VAERS report
2022-02-24	Successful 2022-04-19	Does not wish to fill out VAERS report

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-27

Systemic reaction (other): On the fifth day, I experienced rash redness pain and itching. It lasted about an hour and a half and slowly dissipated.

Release 3 — day 14, dose 1

2021-02-04

Symptoms: On 31 January I experienced my second possible reaction to the first vaccination. I broke out in a rash with itching and cold chills. It lasted an hour and a half to two hours

Healthcare visit (other): Just reported this second incident through my doctors portal

Release 4 — days 1–6 daily, dose 2

2021-03-02

Systemic reaction (other): Itching on feet and joints. Swelling and redness on face, joints and feet

Release 6 — day 28, dose 2

2021-03-24

Symptoms: This is the fourth episode of swelling and redness. It was from head to toe this time and lasted approximately two hours as did the other three episodes

Release 11 — 12 months, dose 2

2022-02-24

Symptoms: I just want to take this opportunity to let you know that after 2 Moderno vaccinations and having 5 adverse reactions, I was advised by my physician to receive a J&J booster. I had no adverse reactions from this booster.

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	Unevaluable event	✓	✓	✓
SD	Adverse reaction	·	·	✓
SD	Chills	✓	✓	✓
SD	Erythema	✓	✓	✓
SD	Office visit	·	·	✓
SD	Rash	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SD	Swelling	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Swelling face	✓	✓	✓

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