YRX-17632-89318
4 vaccinations
6 coded responses
36 check-ins
6 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 921 / CA
- Registered
- 2021-01-17
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-16
Dose 1 — Moderna
-
2021-01-17
Registered in v-safe
- 2021-01-17
- 2021-01-18
- 2021-01-19
- 2021-01-21
- 2021-01-22
- 2021-01-23
- 2021-01-30
- 2021-02-06
-
2021-02-13
Dose 2 — Moderna
- 2021-02-13
-
2021-02-14
Survey response — days 1–6 daily, dose 2MedDRA: Decreased appetite — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesFree text: No appetite.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-15
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-02-16
- 2021-02-19
- 2021-02-20
- 2021-02-27
- 2021-03-06
- 2021-03-13
- 2021-03-20
-
2021-03-27
Survey response — day 42, dose 2MedDRA: Office visit, Sinonasal obstruction, Sinuplasty, Sinus operation — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Sinus surgery to clear blockage · Healthcare visit (other): In office procedure. Balloon sinuplasty.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-27
Report sent to call center — day 42, dose 2Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-05-15
- 2021-08-14
-
2021-11-16
Dose 3 — Moderna
-
2022-02-13
Survey response — 12 months, dose 2MedDRA: Abdominal pain lower, Nephrolithiasis, Office visit, Renal stone removal — Feeling: Good · 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: Symptoms: 1. Severe lower abdominal pain. CT scan. Resolved without intervention. 2. Kidney stone. Non-acute. Reoccurrence. Removed via a minimally invasive procedure. · Healthcare visit (other): Office visits with GI and urological specialists specialists. Outpatient urological procedure to remove kidney stone.MedDRA releases: 2024-11 · check-in free text available
-
2022-02-13
Report sent to call center — 12 months, dose 2Be 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)
-
2022-02-15
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-11-22
Dose 4 — Moderna
-
2022-11-23
Health check-in — days 1–6 daily, dose 4Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2022-11-24
Survey response — days 1–6 daily, dose 4MedDRA: Impatience — Feeling: GoodFree text: Impatience with waiter.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-25
Survey response — days 1–6 daily, dose 4MedDRA: Fatigue — Feeling: GoodFree text: Exhausted dealing with car dealer.MedDRA releases: 2024-11 · check-in free text available
- 2022-11-26
- 2022-11-27
- 2022-11-28
- 2022-11-29
- 2022-12-08
- 2022-12-13
-
2022-12-20
Survey response — day 28, dose 4MedDRA: Hypertension — Feeling: GoodFree text: Episodes of unrelated hypertensionMedDRA releases: 2024-11 · check-in free text available
- 2022-12-27
- 2023-01-03
- 2023-02-21
- 2023-05-23
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-16 | Moderna | |
| 2 | 2021-02-13 | Moderna | |
| 3 | 2021-11-16 | Moderna | No |
| 4 | 2022-11-22 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-03-27 | Successful | Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2022-02-13 | Successful 2022-02-15 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): No appetite.
Release 6 — day 42, dose 2
Symptoms: Sinus surgery to clear blockage
Healthcare visit (other): In office procedure. Balloon sinuplasty.
Release 11 — 12 months, dose 2
Symptoms: 1. Severe lower abdominal pain. CT scan. Resolved without intervention. 2. Kidney stone. Non-acute. Reoccurrence. Removed via a minimally invasive procedure.
Healthcare visit (other): Office visits with GI and urological specialists specialists. Outpatient urological procedure to remove kidney stone.
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): Impatience with waiter.
Systemic reaction (other): Exhausted dealing with car dealer.
Release 12 — day 28, dose 4
Symptoms: Episodes of unrelated hypertension
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 | Renal stone removal | · | · | ✓ |
| HCVO | Sinuplasty | ✓ | ✓ | ✓ |
| SD | Abdominal pain lower | · | · | ✓ |
| SD | Hypertension | · | · | ✓ |
| SD | Nephrolithiasis | · | · | ✓ |
| SD | Renal stone removal | · | · | ✓ |
| SD | Sinonasal obstruction | ✓ | ✓ | ✓ |
| SD | Sinus operation | ✓ | ✓ | ✓ |
| SRO | Decreased appetite | ✓ | ✓ | ✓ |
| SRO | Fatigue | · | · | ✓ |
| SRO | Impatience | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release