ZM4-18132-69759

2 vaccinations 5 coded responses 23 check-ins 5 free-text entries 5 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 064 / CT
Registered: 2021-01-01

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

2020-12-31
Dose 1 — Moderna
2021-01-01
Registered in v-safe
2021-01-01
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-01-01
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-07
Health check-in — 7 day, dose 1
Feeling: Good · None

Adult check-in
2021-01-16
Survey response — 14 day, dose 1
MedDRA: Injection site erythema, Injection site induration, Injection site rash, Injection site swelling, Injection site warmth — Feeling: Good

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-01-21
Health check-in — 21 day, dose 1
Feeling: Good

Adult check-in
2021-01-28
Dose 2 — Moderna
2021-01-28
Health check-in — 0 day, dose 2
Feeling: Good · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

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

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-04
Health check-in — 7 day, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-02-11
Health check-in — 14 day, dose 2
Feeling: Good

Adult check-in
2021-02-18
Survey response — 21 day, dose 2
MedDRA: Rash macular — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-18
Report sent to call center — 21 day, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-25
Survey response — 28 day, dose 2
MedDRA: Pityriasis rosea, Rash, Skin lesion — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-25
Report sent to call center — 28 day, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-04
Survey response — 35 day, dose 2
MedDRA: Condition aggravated, Pityriasis rosea, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-04
Report sent to call center — 35 day, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-11
Survey response — 42 day, dose 2
MedDRA: Office visit, Pityriasis rosea, Risk of future pregnancy miscarriage — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-11
Report sent to call center — 42 day, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-01
Health check-in — 3 month, dose 2
Feeling: Good

Adult check-in
2021-05-25
Call 1 — Left Voicemail
2021-05-28
Call successful
Participant prefers to complete VAERS report online
2021-08-04
Health check-in — 6 month, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-31	Moderna
2	2021-01-28	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-01	priority 2/3
2021-02-18	Successful	Participant prefers to complete VAERS report online
2021-02-25	Successful	Participant prefers to complete VAERS report online
2021-03-04	Successful	Participant prefers to complete VAERS report online
2021-03-11	Successful 2021-05-28	Participant prefers to complete VAERS report online

Free text

Release 2

Symptoms: On day 15 after vaccine, underneath the injection site is warm to touch and theres a rectangular red rash that is hard and swollen.

Release 4

Symptoms: Spotted Rash covering my entire abdomen, breasts, nipples, chest and now going up my neck. Have a telehealth appointment with a dermatologist today to discuss. Started ten days after 2nd dose of vaccine

Symptoms: Worsening rash and lesions , diagnosed as pityariasis rosea possibly related to second dose of vaccine. Will follow up with dermatologist in two weeks for an in office visit. Using topical steroid cream, however rash is spreading not improving

Release 5

Symptoms: Worsening pityriasis rosea. Followed by dermatologist. Spreading to groin area and legs now.

Symptoms: Continue to have pityriasis rosea, spreading down to groin and legs. Have been to dermatologist who believes it is caused by second dose of COVID vaccine Told by my OBGYN I have an increased risk of miscarriage advised to hold off on getting pregnant cut off by CDC

Free-text releases are not linked to a specific 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	Condition aggravated	✓	✓	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site induration	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Injection site swelling	✓	✓	✓
SD	Injection site warmth	✓	✓	✓
SD	Office visit	✓	·	✓
SD	Pityriasis rosea	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash macular	✓	✓	✓
SD	Risk of future pregnancy miscarriage	✓	✓	✓
SD	Skin lesion	✓	✓	✓

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