Y8G-27254-15559
3 vaccinations
3 coded responses
39 check-ins
3 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 36-40
- ZIP prefix
- 100 / NY
- Registered
- 2021-04-02
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-04-02
Registered in v-safe
-
2021-04-02
Dose 1 — Moderna
- 2021-04-02
- 2021-04-04
- 2021-04-05
-
2021-04-06
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
-
2021-04-07
Survey response — days 1–6 daily, dose 1MedDRA: Eye pain, Nasal disorder, Pain in extremity — Feeling: Fair · HeadacheFree text: Im having a bit of sore eyes and nose, but it may be seasonal allergyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-08
- 2021-04-09
- 2021-04-16
- 2021-04-23
- 2021-04-30
-
2021-05-02
Dose 2 — Moderna
- 2021-05-02
-
2021-05-03
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
- 2021-05-04
- 2021-05-05
- 2021-05-06
- 2021-05-08
- 2021-05-09
- 2021-05-16
- 2021-05-23
- 2021-05-30
- 2021-06-06
- 2021-06-14
- 2021-08-01
- 2021-10-31
-
2021-12-28
Dose 3 — Moderna
- 2021-12-28
-
2021-12-29
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activitiesAdult check-in
-
2021-12-30
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, NauseaAdult check-in
-
2021-12-31
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
-
2022-01-01
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
- 2022-01-02
- 2022-01-03
- 2022-01-04
- 2022-01-11
-
2022-01-19
Survey response — day 21, dose 3MedDRA: Hypersensitivity, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: I'm having an allergic reaction, not sure what is causing it, but I already check with a doctor and we are waiting lab results.MedDRA releases: 2024-11 · check-in free text available
-
2022-01-19
Report sent to call center — day 21, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-01-20
- 2022-01-25
-
2022-01-27
Survey response — day 28, dose 3MedDRA: Asthma, Dermatitis allergic, Office visit — 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 · Outpatient clinic or urgent care clinic visitFree text: I'm having asthma symptoms like. I'm using an inhaler for now, but still checking with doctors to see what's going on. The last doctor told me maybe heartburn is the cause, and a skin allergic reaction it's just a bad coincidenceMedDRA releases: 2024-11 · check-in free text available
-
2022-01-27
Report sent to call center — day 28, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-01-28
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-02-01
- 2022-02-10
- 2022-03-29
- 2022-06-28
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-02 | Moderna | |
| 2 | 2021-05-02 | Moderna | |
| 3 | 2021-12-28 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-01-19 | Successful | Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2022-01-27 | Successful 2022-01-28 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 7 — days 1–6 daily, dose 1
Systemic reaction (other): Im having a bit of sore eyes and nose, but it may be seasonal allergy
Release 10 — day 21, dose 3
Symptoms: I'm having an allergic reaction, not sure what is causing it, but I already check with a doctor and we are waiting lab results.
Release 11 — day 28, dose 3
Symptoms: I'm having asthma symptoms like. I'm using an inhaler for now, but still checking with doctors to see what's going on. The last doctor told me maybe heartburn is the cause, and a skin allergic reaction it's just a bad coincidence
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 | Asthma | · | · | ✓ |
| SD | Dermatitis allergic | · | · | ✓ |
| SD | Hypersensitivity | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SRO | Eye pain | ✓ | ✓ | ✓ |
| SRO | Nasal disorder | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release