YL9-24468-09094
2 vaccinations
5 coded responses
18 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 240 / VA
- Registered
- 2021-03-10
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-09
Dose 1 — Moderna
-
2021-03-10
Registered in v-safe
-
2021-03-10
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-11
Survey response — days 1–6 daily, dose 1MedDRA: Pain in extremity — Feeling: Fair · Muscle or body aches, Fatigue or tirednessFree text: Pain in an area about three inches above where I received the injection.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-12
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-14
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: Good · Headache, Muscle or body aches, Fatigue or tirednessFree text: I am feeling back to the way I was before I received the vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-15
Health check-in — days 1–6 daily, dose 1Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-16
Health check-in — day 7, dose 1Feeling: Good · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-03-23
Survey response — day 14, dose 1MedDRA: Ear infection, Ear pain, Facial pain, Headache, Nasopharyngitis, Pyrexia, Sinus disorder — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Yes, I feel like I have a bad cold with possible sinus and ear infection - honestly, facial pain, ear pain, headache, mild fever.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-01
- 2021-04-06
-
2021-04-08
Dose 2 — Moderna
-
2021-04-13
Survey response — days 1–6 daily, dose 2MedDRA: Immunisation reaction — Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Fatigue or tirednessFree text: I started having a reaction to the vaccine within 5 minutes. For two days I felt very sick.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-15
- 2021-04-24
- 2021-04-29
- 2021-05-06
- 2021-05-20
- 2021-07-08
-
2021-10-07
Survey response — 6 months, dose 2MedDRA: Ear infection, Nasopharyngitis, Office visit, Sinusitis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Sinus infection, ear infection, bad cold · Healthcare visit (other): My primary physician in her office.MedDRA releases: 2024-11 · check-in free text available
-
2021-10-07
Report sent to call center — 6 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-12-06
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-04-08
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-09 | Moderna | |
| 2 | 2021-04-08 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-10-07 | Successful 2021-12-06 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Pain in an area about three inches above where I received the injection.
Systemic reaction (other): I am feeling back to the way I was before I received the vaccine.
Release 6 — day 14, dose 1
Symptoms: Yes, I feel like I have a bad cold with possible sinus and ear infection - honestly, facial pain, ear pain, headache, mild fever.
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): I started having a reaction to the vaccine within 5 minutes. For two days I felt very sick.
Release 10 — 6 months, dose 2
Symptoms: Sinus infection, ear infection, bad cold
Healthcare visit (other): My primary physician in her 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
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| HCVO | Office visit | · | · | ✓ |
| SD | Ear infection | ✓ | ✓ | ✓ |
| SD | Ear pain | ✓ | ✓ | ✓ |
| SD | Facial pain | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Sinus disorder | ✓ | ✓ | ✓ |
| SD | Sinusitis | · | · | ✓ |
| SRO | Immunisation reaction | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release