YVK-18948-99645
4 vaccinations
8 coded responses
49 check-ins
7 free-text entries
6 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 381 / TN
- Registered
- 2021-02-23
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
BXA-11127-40378
Adult relative or friend · Male · 2021-10-27
Timeline
-
2021-02-23
Registered in v-safe
-
2021-02-23
Dose 1 — Moderna
- 2021-02-23
- 2021-02-24
-
2021-02-25
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
-
2021-02-26
Survey response — days 1–6 daily, dose 1MedDRA: Insomnia — Feeling: Fair · Fatigue or tirednessFree text: Sleep has been more difficult than usual it seems for last 2 days (but probably not related)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-11
- 2021-03-16
- 2021-03-23
-
2021-03-24
Dose 2 — Moderna
- 2021-03-24
- 2021-03-25
- 2021-03-26
- 2021-03-27
- 2021-03-28
- 2021-03-29
- 2021-03-30
- 2021-03-31
- 2021-04-07
- 2021-04-14
- 2021-04-21
- 2021-04-28
- 2021-05-05
- 2021-06-23
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2021-09-22
Survey response — 6 months, dose 2MedDRA: Hospitalisation, Lacunar stroke, Magnetic resonance imaging abnormal, Memory impairment — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Stroke. Lacunar in left hippocampus. September 10, 2021. Memory only for 6-8 hours. No changes in motor function. Hospitalized for 37 hours. All other tests and bloodwork WNl (CT CTA TEE EEG. Lacunar spot found only on MRI. Vital signs all normMedDRA releases: 2024-11 · check-in free text available
-
2021-09-22
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)
-
2021-09-28
Call successfulReported to VAERS voluntarily prior to GDIT contact
-
2021-10-26
Dose 3 — Moderna
-
2021-10-27
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Headache, Fatigue or tirednessAdult check-in
- 2021-10-28
- 2021-10-31
- 2021-11-04
-
2021-11-09
Survey response — day 14, dose 3MedDRA: Cerebrovascular accident, Dizziness, Emergency care, Nausea, Vomiting — 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 · Emergency room or emergency department visitFree text: Friday November 5, sudden onset dizziness, nausea, vomiting. Note: first stroke was September 10. I went to the ER to make sure not having a second stroke. Tests, including Brain CAt and MRI negative.MedDRA releases: 2024-11 · check-in free text available
-
2021-11-09
Report sent to call center — day 14, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prEmergency room or emergency department visit · 1 call case(s)
- 2021-11-11
-
2021-11-11
Call successfulReported to VAERS voluntarily prior to GDIT contact
- 2021-11-23
- 2021-12-07
-
2022-01-25
Survey response — 3 months, dose 3MedDRA: Atrial septal defect, Cerebrovascular accident, Hospitalisation, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Small stroke 09.10.21. Possible cause Patent Foramen Ovale found November. No other cause identified. · Healthcare visit (other): Outpatient hospital procedure after the September hospitalization.MedDRA releases: 2024-11 · check-in free text available
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2022-01-25
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professional1 call case(s)
- 2022-01-27
-
2022-04-26
Survey response — 6 months, dose 3MedDRA: Atrial septal defect repair, Pre-existing disease — Feeling: Good · 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: Procedure: closed my PFO April 21, 2922. PFO found November 2021 after September stroke.MedDRA releases: 2024-11 · check-in free text available
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2022-04-26
Report sent to call center — 6 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-04-27
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-11-18
Dose 4 — Pfizer-BioNTech
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2022-11-19
Survey response — days 1–6 daily, dose 4MedDRA: Angina pectoris, Chest pain — Feeling: Fair · Site: Pain · HeadacheFree text: Chest heart pain started 24 hours post shot; intermittent. Mild and not frequentMedDRA releases: 2024-11 · check-in free text available
- 2022-11-20
- 2022-11-21
- 2022-11-22
- 2022-11-23
- 2022-11-24
- 2022-11-25
- 2022-12-02
- 2022-12-09
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2022-12-16
Survey response — day 28, dose 4MedDRA: Influenza — Feeling: Poor · 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: Flu was diagnosed 12.14.22MedDRA releases: 2024-11 · check-in free text available
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2022-12-16
Report sent to call center — day 28, dose 4Be 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)
-
2022-12-19
Call successfulDoes not wish to fill out VAERS report
- 2022-12-23
- 2022-12-30
- 2023-02-17
-
2023-05-19
Survey response — 6 months, dose 4MedDRA: Neuralgia — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-05-19
Report sent to call center — 6 months, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2023-05-22
Call successfulReported to VAERS voluntarily prior to GDIT contact
-
2023-05-22
Call successfulReported to VAERS voluntarily prior to GDIT contact
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-23 | Moderna | |
| 2 | 2021-03-24 | Moderna | |
| 3 | 2021-10-26 | Moderna | No |
| 4 | 2022-11-18 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-09-22 | Successful 2021-09-28 |
Reported to VAERS voluntarily prior to GDIT contact |
| 2021-11-09 | Successful 2021-11-11 |
Reported to VAERS voluntarily prior to GDIT contact |
| 2022-01-25 | Successful 2023-05-22 |
Reported to VAERS voluntarily prior to GDIT contact |
| 2022-04-26 | Successful 2022-04-27 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-12-16 | Successful 2022-12-19 |
Does not wish to fill out VAERS report |
| 2023-05-19 | Successful 2023-05-22 |
Reported to VAERS voluntarily prior to GDIT contact |
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Sleep has been more difficult than usual it seems for last 2 days (but probably not related)
Release 9 — 6 months, dose 2
Symptoms: Stroke. Lacunar in left hippocampus. September 10, 2021. Memory only for 6-8 hours. No changes in motor function. Hospitalized for 37 hours. All other tests and bloodwork WNl (CT CTA TEE EEG. Lacunar spot found only on MRI. Vital signs all norm cut off by CDC
Release 10 — day 14, dose 3
Symptoms: Friday November 5, sudden onset dizziness, nausea, vomiting. Note: first stroke was September 10. I went to the ER to make sure not having a second stroke. Tests, including Brain CAt and MRI negative.
Release 11 — 3 months, dose 3
Symptoms: Small stroke 09.10.21. Possible cause Patent Foramen Ovale found November. No other cause identified.
Healthcare visit (other): Outpatient hospital procedure after the September hospitalization.
Release 11 — 6 months, dose 3
Symptoms: Procedure: closed my PFO April 21, 2922. PFO found November 2021 after September stroke.
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): Chest heart pain started 24 hours post shot; intermittent. Mild and not frequent
Release 12 — day 28, dose 4
Symptoms: Flu was diagnosed 12.14.22
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 | Hospitalisation | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| SD | Atrial septal defect | · | · | ✓ |
| SD | Atrial septal defect repair | · | · | ✓ |
| SD | Cerebrovascular accident | · | · | ✓ |
| SD | Dizziness | · | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Hospitalisation | · | · | ✓ |
| SD | Influenza | · | · | ✓ |
| SD | Lacunar stroke | · | · | ✓ |
| SD | Magnetic resonance imaging abnormal | · | · | ✓ |
| SD | Memory impairment | · | · | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Neuralgia | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Vomiting | · | · | ✓ |
| SRO | Angina pectoris | · | · | ✓ |
| SRO | Chest pain | · | · | ✓ |
| SRO | Insomnia | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release