YXL-51434-97345
1 vaccination
3 coded responses
9 check-ins
3 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 0-4
- ZIP prefix
- 020 / MA
- Registered
- 2022-06-28
- Relationship
- Child or adolescent in my care
- Guardian
- 6KZ-38765-12848
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2022-06-27
Dose 1 — Moderna
-
2022-06-28
Registered in v-safe
- 2022-06-28
- 2022-06-30
- 2022-07-01
- 2022-07-02
- 2022-07-03
- 2022-07-04
-
2022-07-11
Survey response — day 14, dose 1, under 3MedDRA: Conjunctivitis, Ear disorder, Pyrexia, SARS-CoV-2 test negative — Feeling: Fair · 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: Low grade fevers this past week. Some ear irritation, but not infected yet. Started with conjunctivitis today. Likely unrelated but accurately sharing current health. Covid negative.MedDRA releases: 2024-11 · check-in free text available
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2022-07-11
Report sent to call center — day 14, dose 1, under 3Be 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)
-
2022-07-12
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2022-07-21
Survey response — day 21, dose 1, under 3MedDRA: Pre-existing disease, Pyrexia — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Has had fevers in the last week. Now mostly just an elevated temp. Does have a history or prolonged fevers at time in the past, but including to be accurate and transparent.MedDRA releases: 2024-11 · check-in free text available
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2022-07-21
Report sent to call center — day 21, dose 1, under 3Be unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-07-22
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2022-08-01
Survey response — day 35, dose 1, under 3MedDRA: COVID-19, Medical counselling, Pyrexia — 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 · Telehealth, virtual health, or email health consultationFree text: Fever of 103.6 from contracting Covid. We were going to be away the week she was due for her 2nd shot so we tried to get it 3 days early but despite talking to the urgent care to get it approved to do it 3 days early, when we arrived they refused.MedDRA releases: 2024-11 · check-in free text available
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2022-08-01
Report sent to call center — day 35, dose 1, under 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · 1 call case(s)
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2022-08-02
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 | 2022-06-27 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-07-11 | Successful 2022-07-12 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-07-21 | Successful 2022-07-22 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-08-01 | Successful 2022-08-02 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 12 (Under 3) — day 14, dose 1, under 3
Symptoms: Low grade fevers this past week. Some ear irritation, but not infected yet. Started with conjunctivitis today. Likely unrelated but accurately sharing current health. Covid negative.
Release 12 (Under 3) — day 21, dose 1, under 3
Symptoms: Has had fevers in the last week. Now mostly just an elevated temp. Does have a history or prolonged fevers at time in the past, but including to be accurate and transparent.
Release 12 (Under 3) — day 35, dose 1, under 3
Symptoms: Fever of 103.6 from contracting Covid. We were going to be away the week she was due for her 2nd shot so we tried to get it 3 days early but despite talking to the urgent care to get it approved to do it 3 days early, when we arrived they refused.
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 |
|---|---|---|---|---|
| SD | Conjunctivitis | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Ear disorder | · | · | ✓ |
| SD | Medical counselling | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release