Y9N-23901-01755
4 vaccinations
6 coded responses
42 check-ins
5 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 36-40
- ZIP prefix
- 618 / IL
- Registered
- 2021-04-23
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-24
Dose 1 — Moderna
-
2021-04-21
Dose 2 — Moderna
-
2021-04-23
Registered in v-safe
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2021-04-23
Survey response — days 1–6 daily, dose 2MedDRA: Formication — Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Abdominal painFree text: Phantom sensation of insects crawling on skinMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-24
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-04-26
-
2021-04-27
Health check-in — days 1–6 daily, dose 2Feeling: Good · Chills, Fatigue or tirednessAdult check-in
- 2021-04-28
- 2021-05-05
- 2021-05-12
- 2021-05-19
-
2021-05-26
Survey response — day 35, dose 2MedDRA: Muscle spasms — Feeling: FairFree text: Strong muscle cramps particularly in calf muscles, although it likely might be running-related, not vaccine-related.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-06-02
Survey response — day 42, dose 2MedDRA: Back injury, Muscle spasms — Feeling: FairFree text: Lower back injury very likely from gardening, not from the vaccine. I have some muscle cramping but that's pretty normal with running.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-07-21
- 2021-10-20
-
2021-11-22
Dose 3 — Moderna
- 2021-11-22
-
2021-11-23
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain · Fever · Chills, Headache, Fatigue or tirednessAdult check-in
- 2021-11-24
- 2021-11-25
- 2021-11-26
- 2021-11-27
- 2021-11-28
- 2021-11-29
- 2021-12-06
- 2021-12-13
- 2021-12-20
- 2021-12-27
- 2022-01-03
- 2022-02-21
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2022-05-25
Survey response — 6 months, dose 3MedDRA: Eye disorder, Unevaluable event, Visual impairment — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Gray spot in vision caused by either blood vessel inflammation, plasma settling on the retina, or potentially a stroke. The vision issue cleared up but the doctors want a follow-up echocardiogram, cranial vessel ultrasound, and blood tests. · Healthcare visit (other): Eye exam, fluorescein angiographyMedDRA releases: 2024-11 · check-in free text available
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2022-05-25
Report sent to call center — 6 months, dose 3Be unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-05-26
-
2022-10-04
Dose 4 — Moderna
- 2022-10-04
-
2022-10-05
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-10-06
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Headache, Fatigue or tirednessAdult check-in
- 2022-10-07
- 2022-10-08
- 2022-10-09
- 2022-10-10
- 2022-10-13
- 2022-10-18
- 2022-10-25
- 2022-11-01
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2022-11-08
Survey response — day 35, dose 4MedDRA: Diarrhoea, Pyrexia, SARS-CoV-2 test negative — Feeling: GoodFree text: Low fever and diarrhea, but probably not from the vaccine. My COVID home test was negative and it resolved in a few days.MedDRA releases: 2024-11 · check-in free text available
- 2022-11-15
-
2023-01-03
Survey response — 3 months, dose 4MedDRA: Antiphospholipid antibodies positive, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professionalMedDRA releases: 2024-11
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2023-01-03
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
- 2023-01-04
- 2023-01-04
-
2023-01-05
Call successfulCompleted over the phone
-
2023-01-05
Call successfulDoes not wish to fill out VAERS report
- 2023-04-06
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-24 | Moderna | |
| 2 | 2021-04-21 | Moderna | |
| 3 | 2021-11-22 | Moderna | No |
| 4 | 2022-10-04 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-05-25 | Successful 2023-01-05 |
Completed over the phone |
| 2023-01-03 | Successful 2023-01-05 |
Does not wish to fill out VAERS report |
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Phantom sensation of insects crawling on skin
Release 8 — day 35, dose 2
Symptoms: Strong muscle cramps particularly in calf muscles, although it likely might be running-related, not vaccine-related.
Release 8 — day 42, dose 2
Symptoms: Lower back injury very likely from gardening, not from the vaccine. I have some muscle cramping but that's pretty normal with running.
Release 11 — 6 months, dose 3
Symptoms: Gray spot in vision caused by either blood vessel inflammation, plasma settling on the retina, or potentially a stroke. The vision issue cleared up but the doctors want a follow-up echocardiogram, cranial vessel ultrasound, and blood tests.
Healthcare visit (other): Eye exam, fluorescein angiography
Release 12 — day 35, dose 4
Symptoms: Low fever and diarrhea, but probably not from the vaccine. My COVID home test was negative and it resolved in a few days.
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 | Office visit | · | · | ✓ |
| HCVO | Unevaluable event | · | · | ✓ |
| SD | Antiphospholipid antibodies positive | · | · | ✓ |
| SD | Back injury | ✓ | ✓ | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Eye disorder | · | · | ✓ |
| SD | Muscle spasms | ✓ | ✓ | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Visual impairment | · | · | ✓ |
| SRO | Formication | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release