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YEY-28097-28768

5 vaccinations 5 coded responses 28 check-ins 5 free-text entries 3 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
604 / IL
Registered
2021-02-24
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-28
    Dose 1 — Moderna
  2. 2021-02-22
    Dose 2 — Moderna
  3. 2021-02-24
    Registered in v-safe
  4. 2021-02-24
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  5. 2021-02-24
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  6. 2021-02-25
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  7. 2021-02-26
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  8. 2021-02-27
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  9. 2021-02-28
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  10. 2021-03-01
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  11. 2021-03-08
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  12. 2021-03-15
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  13. 2021-03-22
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  14. 2021-03-29
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  15. 2021-04-05
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  16. 2021-05-24
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-08-23
    Survey response — 6 months, dose 2
    MedDRA: Ear infection, Sinusitis — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Sinus/ear infection diagnosed 8/17. Unrelated to vaccination.
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  18. 2021-08-23
    Report sent to call center — 6 months, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  19. 2021-08-28
  20. 2021-08-30
  21. 2021-08-30
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  22. 2021-11-09
    Dose 3 — Moderna
  23. 2022-02-24
    Health check-in — 12 months, dose 2
    Feeling: Good
    Adult check-in
  24. 2022-04-01
    Dose 4 — Moderna
  25. 2022-04-27
    Survey response — day 21, dose 4
    MedDRA: Gastritis, Office visit, Sinusitis — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional
    Free text: Symptoms: Not vaccine-related! Sinusitis and gastritis. Being treated. · Healthcare visit (other): Office visits, lab tests, CT
    MedDRA releases: 2024-11 · check-in free text available
  26. 2022-04-27
    Report sent to call center — day 21, dose 4
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  27. 2022-04-28
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  28. 2022-04-29
    Health check-in — day 28, dose 4
    Feeling: Good
    Adult check-in
  29. 2022-05-06
    Health check-in — day 35, dose 4
    Feeling: Good
    Adult check-in
  30. 2022-05-13
    Health check-in — day 42, dose 4
    Feeling: Good
    Adult check-in
  31. 2022-07-02
    Health check-in — 3 months, dose 4
    Feeling: Good
    Adult check-in
  32. 2022-09-16
    Dose 5 — Moderna
    Co-administered: Flu
  33. 2022-09-30
    Survey response — 6 months, dose 4
    MedDRA: Gastritis, Pre-existing disease, Upper respiratory tract infection — Feeling: Good · Be unable to do your normal daily activities
    Free text: Flare-up of chronic gastritis followed by a upper respiratory infection that I've had for 8 days!
    MedDRA releases: 2024-11 · check-in free text available
  34. 2022-10-01
    Survey response — day 14, dose 5
    MedDRA: Decreased appetite, Gastritis, Lethargy, Malaise, Nasopharyngitis, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities
    Free text: The day after third booster and flu shot, was extremely lethargic, had no appetite. Lack of appetite persisted 2 days. Immediately after that, chronic gastritis flared. Ill for 3-4 days. Then came down with cold. In day 9 of that now, but improving.
    MedDRA releases: 2024-11 · check-in free text available
  35. 2022-10-08
    Survey response — day 21, dose 5
    MedDRA: Gastritis, Office visit, Pre-existing disease, Sinusitis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional
    Free text: Symptoms: I have a sinus infection and my gastritis flared yesterday. Taking an antibiotic for the sinuses. · Healthcare visit (other): Saw my ENT in the office.
    MedDRA releases: 2024-11 · check-in free text available
  36. 2022-10-08
    Report sent to call center — day 21, dose 5
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  37. 2022-10-10
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  38. 2022-10-16
    Health check-in — day 28, dose 5
    Feeling: Fair
    Adult check-in
  39. 2022-10-21
    Health check-in — day 35, dose 5
    Feeling: Good
    Adult check-in
  40. 2022-10-28
    Health check-in — day 42, dose 5
    Feeling: Good
    Adult check-in
  41. 2022-12-16
    Health check-in — 3 months, dose 5
    Feeling: Good
    Adult check-in
  42. 2023-03-17
    Health check-in — 6 months, dose 5
    Feeling: Fair
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-01-28Moderna
22021-02-22Moderna
32021-11-09Moderna No
42022-04-01Moderna No
52022-09-16Moderna Flu

Call center

ReportedOutcomeVAERS-related outcome
2021-08-23 Successful
2021-08-30
 Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-27 Successful
2022-04-28
 Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-08 Successful
2022-10-10
 Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 9 — 6 months, dose 2

2021-08-23

Symptoms: Sinus/ear infection diagnosed 8/17. Unrelated to vaccination.

Release 11 — day 21, dose 4

2022-04-27

Symptoms: Not vaccine-related! Sinusitis and gastritis. Being treated.
Healthcare visit (other): Office visits, lab tests, CT

Release 12 — 6 months, dose 4

2022-09-30

Symptoms: Flare-up of chronic gastritis followed by a upper respiratory infection that I've had for 8 days!

Release 12 — day 14, dose 5

2022-10-01

Symptoms: The day after third booster and flu shot, was extremely lethargic, had no appetite. Lack of appetite persisted 2 days. Immediately after that, chronic gastritis flared. Ill for 3-4 days. Then came down with cold. In day 9 of that now, but improving. cut off by CDC

Release 12 — day 21, dose 5

2022-10-08

Symptoms: I have a sinus infection and my gastritis flared yesterday. Taking an antibiotic for the sinuses.
Healthcare visit (other): Saw my ENT in the office.

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
HCVOOffice visit · · ✓
SDDecreased appetite · · ✓
SDEar infection ✓ · ✓
SDGastritis · · ✓
SDLethargy · · ✓
SDMalaise · · ✓
SDNasopharyngitis · · ✓
SDPre-existing disease · · ✓
SDSinusitis ✓ · ✓
SDUpper respiratory tract infection · · ✓

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

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