YQJ-71093-95810
4 vaccinations
9 coded responses
53 check-ins
8 free-text entries
4 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 980 / WA
- Registered
- 2021-01-02
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-02
Registered in v-safe
-
2021-01-02
Dose 1 — Moderna
- 2021-01-02
- 2021-01-03
- 2021-01-04
- 2021-01-05
- 2021-01-06
- 2021-01-07
- 2021-01-08
- 2021-01-09
- 2021-01-16
- 2021-01-23
-
2021-01-26
Dose 2 — Moderna
- 2021-01-26
-
2021-01-27
Survey response — days 1–6 daily, dose 2MedDRA: Abulia, Disturbance in attention, Feeling abnormal — Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, NauseaFree text: Spicy... hard to focus, make decisionsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-28
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-01-29
- 2021-01-30
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-09
- 2021-02-16
- 2021-02-23
- 2021-03-02
- 2021-03-09
- 2021-04-27
- 2021-07-27
-
2021-10-23
Dose 3 — Pfizer-BioNTech
-
2021-10-23
Survey response — day 0, dose 3MedDRA: Disturbance in attention, Feeling abnormal — Feeling: Fair · Headache, Fatigue or tirednessFree text: Spacey slight difficulty focusingMedDRA releases: 2024-11 · check-in free text available
-
2021-10-24
Health check-in — days 1–6 daily, dose 3Feeling: Good · Joint pains, Muscle or body achesAdult check-in
- 2021-10-25
- 2021-10-26
- 2021-10-27
- 2021-10-28
- 2021-10-29
- 2021-11-01
-
2021-11-06
Survey response — day 14, dose 3MedDRA: Arthropod bite, Office visit, Rash papular, Rash pruritic, Rash pustular, Self-medication, Sleep disorder — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Small raised bumps, some are / into pustules extremely itchy. I t has made sleeping throughout the night difficult. I had been bitten by ants this last weekend. As a PA-C, I have been self treating with poor results. I have a medical appointment T · Healthcare visit (other): Dermatologist on TuesdayMedDRA releases: 2024-11 · check-in free text available
-
2021-11-06
Report sent to call center — day 14, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2021-11-10
Call successfulDoes not wish to fill out VAERS report
- 2021-11-13
- 2021-11-20
- 2021-11-27
-
2021-12-04
Survey response — day 42, dose 3MedDRA: Cough, Dyspnoea, Headache, Lethargy, Myalgia, Nasopharyngitis, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: FairFree text: Cold like symptoms: runny sinus, lethargic, headache-mild No fever, cough, SOB, myalgias, Covid -19 test negative.MedDRA releases: 2024-11 · check-in free text available
- 2022-01-22
-
2022-04-13
Dose 4 — Moderna
-
2022-04-14
Survey response — days 1–6 daily, dose 4MedDRA: Feeling abnormal — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessFree text: Spicy feelingMedDRA releases: 2024-11 · check-in free text available
- 2022-04-15
- 2022-04-16
- 2022-04-17
- 2022-04-18
-
2022-04-20
Survey response — day 7, dose 4MedDRA: Dyspepsia, Pre-existing disease — Feeling: Fair · Headache, Fatigue or tirednessFree text: Increase in heart burn todayMedDRA releases: 2024-11 · check-in free text available
-
2022-04-27
Survey response — day 14, dose 4MedDRA: Photopsia, Vitreous floaters — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Acute onset of floaters & some flashes in left eye since the last weekend.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-27
Report sent to call center — day 14, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-04-28
- 2022-05-04
- 2022-05-11
- 2022-05-18
- 2022-05-25
- 2022-07-13
-
2022-10-12
Survey response — 6 months, dose 4MedDRA: Medical counselling, SARS-CoV-2 test positive, Self-medication — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: I turned positive for Covid-19 on October 1, 2022. My PCP was contacted. I was able to do self care at home.MedDRA releases: 2024-11 · check-in free text available
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2022-10-12
Report sent to call center — 6 months, dose 4Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-10-13
- 2022-10-13
- 2022-10-14
- 2022-10-14
-
2023-04-13
Survey response — 12 months, dose 4MedDRA: Asthma, Brain fog, Pre-existing disease, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professionalMedDRA releases: 2024-11
-
2023-04-13
Report sent to call center — 12 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
-
2023-04-14
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-04-14
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-04-14
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-02 | Moderna | |
| 2 | 2021-01-26 | Moderna | |
| 3 | 2021-10-23 | Pfizer-BioNTech | No |
| 4 | 2022-04-13 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-11-06 | Successful 2021-11-10 |
Does not wish to fill out VAERS report |
| 2022-04-27 | Successful 2023-04-14 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-10-12 | Successful 2023-04-14 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2023-04-13 | Successful 2023-04-14 |
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 2
Systemic reaction (other): Spicy... hard to focus, make decisions
Release 10 — day 0, dose 3
Systemic reaction (other): Spacey slight difficulty focusing
Release 10 — day 14, dose 3
Symptoms: Small raised bumps, some are / into pustules extremely itchy. I t has made sleeping throughout the night difficult. I had been bitten by ants this last weekend. As a PA-C, I have been self treating with poor results. I have a medical appointment T
Healthcare visit (other): Dermatologist on Tuesday
Release 10 — day 42, dose 3
Symptoms: Cold like symptoms: runny sinus, lethargic, headache-mild No fever, cough, SOB, myalgias, Covid -19 test negative.
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Spicy feeling
Release 11 — day 7, dose 4
Systemic reaction (other): Increase in heart burn today
Release 11 — day 14, dose 4
Symptoms: Acute onset of floaters & some flashes in left eye since the last weekend.
Release 12 — 6 months, dose 4
Symptoms: I turned positive for Covid-19 on October 1, 2022. My PCP was contacted. I was able to do self care at home.
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 | Arthropod bite | · | · | ✓ |
| SD | Asthma | · | · | ✓ |
| SD | Brain fog | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Lethargy | · | · | ✓ |
| SD | Medical counselling | · | · | ✓ |
| SD | Myalgia | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Photopsia | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Rash papular | · | · | ✓ |
| SD | Rash pruritic | · | · | ✓ |
| SD | Rash pustular | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Self-medication | · | · | ✓ |
| SD | Sleep disorder | · | · | ✓ |
| SD | Vitreous floaters | · | · | ✓ |
| SRO | Abulia | ✓ | ✓ | ✓ |
| SRO | Disturbance in attention | ✓ | ✓ | ✓ |
| SRO | Dyspepsia | · | · | ✓ |
| SRO | Feeling abnormal | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release