Y5Q-20284-64056
5 vaccinations
5 coded responses
56 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 961 / CA
- Registered
- 2021-01-22
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-22
Registered in v-safe
-
2021-01-22
Dose 1 — Moderna
- 2021-01-22
-
2021-01-23
Survey response — days 1–6 daily, dose 1MedDRA: Myalgia — Feeling: GoodFree text: Normal deltoid pain from needleMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-24
- 2021-01-25
- 2021-01-26
- 2021-01-27
- 2021-01-28
- 2021-01-29
- 2021-02-05
- 2021-02-12
- 2021-02-19
-
2021-02-25
Dose 2 — Moderna
- 2021-02-26
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-11
- 2021-03-18
- 2021-03-25
- 2021-04-01
- 2021-04-08
- 2021-05-27
- 2021-08-26
-
2021-10-26
Dose 3 — Moderna
- 2021-10-26
- 2021-10-27
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-09
- 2021-11-16
- 2021-11-23
- 2021-11-30
- 2021-12-07
- 2022-01-25
-
2022-04-08
Dose 4 — Moderna
- 2022-04-14
- 2022-04-15
-
2022-04-22
Survey response — day 14, dose 4MedDRA: Decreased appetite, Dyspnoea, Fatigue, Hyperventilation, Nausea — Feeling: Good · Be unable to do your normal daily activitiesFree text: Nauseated, no appetite, fatigued, and necessary for deep breathing because sometimes I couldn't get enough air. I am ok now and back to feeling great for a 79 year living at high altitudes.MedDRA releases: 2024-11 · check-in free text available
- 2022-04-29
- 2022-05-06
-
2022-05-13
Survey response — day 35, dose 4MedDRA: Abdominal discomfort — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Upset stomach probably not related to injrctionyMedDRA releases: 2024-11 · check-in free text available
-
2022-05-13
Report sent to call center — day 35, dose 4Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2022-05-16
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-05-20
- 2022-07-08
-
2022-09-26
Dose 5 — ModernaCo-administered: Flu
- 2022-10-07
- 2022-10-07
- 2022-10-10
-
2022-10-17
Survey response — day 21, dose 5MedDRA: Retching — Feeling: GoodFree text: Wake up in the morning with dry heaves then the condition goes away and I'm fine. Self test negative.MedDRA releases: 2024-11 · check-in free text available
- 2022-10-24
- 2022-10-31
- 2022-11-07
-
2022-12-26
Survey response — 3 months, dose 5MedDRA: Confusional state, Transient ischaemic attack — Feeling: GoodFree text: Probably a TIA. Confusion and. Or knowing where a room was in my daughter's house.MedDRA releases: 2024-11 · check-in free text available
- 2023-03-27
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-22 | Moderna | |
| 2 | 2021-02-25 | Moderna | |
| 3 | 2021-10-26 | Moderna | No |
| 4 | 2022-04-08 | Moderna | No |
| 5 | 2022-09-26 | Moderna | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-05-13 | Successful 2022-05-16 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): Normal deltoid pain from needle
Release 11 — day 14, dose 4
Symptoms: Nauseated, no appetite, fatigued, and necessary for deep breathing because sometimes I couldn't get enough air. I am ok now and back to feeling great for a 79 year living at high altitudes.
Release 11 — day 35, dose 4
Symptoms: Upset stomach probably not related to injrctiony
Release 12 — day 21, dose 5
Symptoms: Wake up in the morning with dry heaves then the condition goes away and I'm fine. Self test negative.
Release 12 — 3 months, dose 5
Symptoms: Probably a TIA. Confusion and. Or knowing where a room was in my daughter's house.
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 | Abdominal discomfort | · | · | ✓ |
| SD | Confusional state | · | · | ✓ |
| SD | Decreased appetite | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Hyperventilation | · | · | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Retching | · | · | ✓ |
| SD | Transient ischaemic attack | · | · | ✓ |
| SRO | Myalgia | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release