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Y4X-10271-24771

6 vaccinations 6 coded responses 38 check-ins 6 free-text entries 3 call cases
Sex
Male
Age at first dose
56-60
ZIP prefix
961 / CA
Registered
2021-03-15
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino
Registered dependents
3QQ-22786-22355 Adult relative or friend · Female · 2022-09-24

Timeline

  1. 2021-03-15
    Registered in v-safe
  2. 2021-03-15
    Dose 1 — Moderna
  3. 2021-03-17
    Health check-in — days 1–6 daily, dose 1
    Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities
    Adult check-in
  4. 2021-03-19
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities
    Adult check-in
  5. 2021-03-20
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Headache
    Adult check-in
  6. 2021-03-21
    Health check-in — day 7, dose 1
    Feeling: Good · Headache, Muscle or body aches
    Adult check-in
  7. 2021-03-28
    Survey response — day 14, dose 1
    MedDRA: Abdominal discomfort, Hospitalisation — Feeling: Good · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization
    Free text: Unrelated to vaccination, I was hospitalized for severe lower abdominal/intestinal distress. Spent two or three days as an in-patient in acute care isolation ward (due to my being immunocompromised).
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-03-28
    Report sent to call center — day 14, dose 1
    Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  9. 2021-04-04
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  10. 2021-04-11
    Health check-in — day 28, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-04-18
    Health check-in — day 35, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-04-19
    Dose 2 — Moderna
  13. 2021-04-25
    Health check-in — day 7, dose 2
    Feeling: Good · Site: Pain · None
    Adult check-in
  14. 2021-05-02
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  15. 2021-05-09
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  16. 2021-05-16
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-05-23
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  18. 2021-05-30
    Survey response — day 42, dose 2
    MedDRA: Nasopharyngitis — Feeling: Good
    Free text: Minor cold-type virus symptoms, including severe canker sores on my tongue, for the past four days. Almost assuredly unrelated to my set of Merdina vaccines, administered well over a month ago.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-07-21
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-10-01
    Dose 3 — Moderna
  21. 2021-10-18
    Survey response — 6 months, dose 2
    MedDRA: Colitis ischaemic, Hospitalisation, Large intestine infection — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities
    Free text: Severe ischemic and infectious colitis attack, with 3 days hospitalization.
    MedDRA releases: 2024-11 · check-in free text available
  22. 2021-10-27
    Survey response — day 21, dose 3
    MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization
    Free text: Ischemic colitis flair-up.
    MedDRA releases: 2024-11 · check-in free text available
  23. 2021-10-27
    Report sent to call center — day 21, dose 3
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
  24. 2021-10-28
  25. 2021-10-31
    Survey response — day 28, dose 3
    MedDRA: Colitis ischaemic — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation
    Free text: Another ischemic colitis attack, severe. Possible infectious colitis as well, but unwilling to present to the ER and be hospitalized for a sixth time this year! Taken three full-strength Mederna vaccinations; yet labs show NO sero-conversion.
    MedDRA releases: 2024-11 · check-in free text available
  26. 2021-10-31
    Report sent to call center — day 28, dose 3
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    Telehealth, virtual health, or email health consultation · 1 call case(s)
  27. 2021-11-03
  28. 2021-11-05
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  29. 2021-11-05
    Call successful
    Participant prefers to complete VAERS report online
  30. 2021-11-12
    Survey response — day 42, dose 3
    MedDRA: Colitis ischaemic — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities
    Free text: Minor-to-mid level ischemic colitis attack, acute.
    MedDRA releases: 2024-11 · check-in free text available
  31. 2022-01-02
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  32. 2022-04-01
    Health check-in — 6 months, dose 3
    Feeling: Good
    Adult check-in
  33. 2022-06-10
    Dose 4 — Moderna
    Co-administered: Other
  34. 2022-06-23
    Dose 5 — Other-Unknown
  35. 2022-06-23
    Health check-in — day 0, dose 5
    Feeling: Good · None
    Adult check-in
  36. 2022-06-24
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  37. 2022-06-25
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  38. 2022-06-26
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  39. 2022-06-27
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  40. 2022-06-28
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  41. 2022-06-29
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  42. 2022-06-30
    Health check-in — day 7, dose 5
    Feeling: Good · None
    Adult check-in
  43. 2022-07-07
    Health check-in — day 14, dose 5
    Feeling: Good
    Adult check-in
  44. 2022-07-14
    Health check-in — day 21, dose 5
    Feeling: Good
    Adult check-in
  45. 2022-07-21
    Health check-in — day 28, dose 5
    Feeling: Good
    Adult check-in
  46. 2022-07-30
    Health check-in — day 35, dose 5
    Feeling: Good
    Adult check-in
  47. 2022-08-04
    Health check-in — day 42, dose 5
    Feeling: Good
    Adult check-in
  48. 2022-09-22
    Health check-in — 3 months, dose 5
    Feeling: Good
    Adult check-in
  49. 2022-09-24
    Dose 6 — Moderna
  50. 2022-09-24
    Health check-in — day 0, dose 6
    Feeling: Good · None
    Adult check-in
  51. 2022-12-24
    Health check-in — 3 months, dose 6
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-03-15Moderna
22021-04-19Moderna
32021-10-01Moderna No
42022-06-10Moderna Other
52022-06-23Other-Unknown No
62022-09-24Moderna No

Call center

ReportedOutcomeVAERS-related outcome
2021-03-28 Successful Participant prefers to complete VAERS report online
2021-10-27 Successful Participant prefers to complete VAERS report online
2021-10-31 Successful
2021-11-05
 Participant prefers to complete VAERS report online

Free text

Release 6 — day 14, dose 1

2021-03-28

Symptoms: Unrelated to vaccination, I was hospitalized for severe lower abdominal/intestinal distress. Spent two or three days as an in-patient in acute care isolation ward (due to my being immunocompromised).

Release 8 — day 42, dose 2

2021-05-30

Symptoms: Minor cold-type virus symptoms, including severe canker sores on my tongue, for the past four days. Almost assuredly unrelated to my set of Merdina vaccines, administered well over a month ago.

Release 10 — 6 months, dose 2

2021-10-18

Symptoms: Severe ischemic and infectious colitis attack, with 3 days hospitalization.

Release 10 — day 21, dose 3

2021-10-27

Symptoms: Ischemic colitis flair-up.

Release 10 — day 28, dose 3

2021-10-31

Symptoms: Another ischemic colitis attack, severe. Possible infectious colitis as well, but unwilling to present to the ER and be hospitalized for a sixth time this year! Taken three full-strength Mederna vaccinations; yet labs show NO sero-conversion.

Release 10 — day 42, dose 3

2021-11-12

Symptoms: Minor-to-mid level ischemic colitis attack, acute.

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

FieldPreferred term2021-092023-042024-11
SDAbdominal discomfort ✓ ✓ ✓
SDColitis ischaemic · · ✓
SDCondition aggravated · · ✓
SDHospitalisation ✓ ✓ ✓
SDLarge intestine infection · · ✓
SDNasopharyngitis ✓ ✓ ✓
SDPre-existing disease · · ✓

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

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