YXZ-10637-23625
4 vaccinations
7 coded responses
52 check-ins
6 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 394 / MS
- Registered
- 2021-01-06
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-06
Registered in v-safe
-
2021-01-06
Dose 1 — Moderna
- 2021-01-06
- 2021-01-07
- 2021-01-08
-
2021-01-09
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-01-10
- 2021-01-11
- 2021-01-12
- 2021-01-13
- 2021-01-20
-
2021-01-27
Survey response — day 21, dose 1MedDRA: Pericarditis — Feeling: GoodFree text: I have had a bad case of pericarditis before, and started getting the same symptoms on Jan 24. I started Ibuprofen 800 mg three times a day which was what my cardiologist put me on before. Symptoms are resolving now. I have an appt next week.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-03
-
2021-02-08
Dose 2 — Moderna
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2021-02-09
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-02-10
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Swelling · Fatigue or tirednessAdult check-in
- 2021-02-11
- 2021-02-12
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-22
- 2021-03-01
- 2021-03-08
-
2021-03-15
Survey response — day 35, dose 2MedDRA: Tinnitus — Feeling: GoodFree text: My ears ring all the time, more noticeable every afternoon. Started more than a week ago but hasnt gone away.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-22
- 2021-05-10
- 2021-08-09
-
2021-11-02
Dose 3 — Moderna
-
2021-11-03
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-11-04
-
2021-11-05
Survey response — days 1–6 daily, dose 3MedDRA: Chest pain — Feeling: Good · Muscle or body achesFree text: Chest pain middle of chestMedDRA releases: 2024-11 · check-in free text available
- 2021-11-06
- 2021-11-07
- 2021-11-08
- 2021-11-09
- 2021-11-16
- 2021-11-23
- 2021-11-30
- 2021-12-07
- 2021-12-14
- 2022-02-01
-
2022-05-31
Dose 4 — Moderna
-
2022-06-01
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, NauseaAdult check-in
- 2022-06-02
- 2022-06-03
- 2022-06-04
- 2022-06-06
- 2022-06-07
- 2022-06-14
- 2022-06-21
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2022-06-28
Survey response — day 28, dose 4MedDRA: Cough, Diarrhoea, Dizziness, Eye irritation, Fatigue, Headache, Oropharyngeal pain, Respiratory tract congestion, Sneezing — Feeling: Poor · 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: Terrible sore throat, cough, headache, congestion, extreme fatigue, sneezing, dizziness, diarrhea, eyes burningMedDRA releases: 2024-11 · check-in free text available
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2022-06-28
Report sent to call center — day 28, 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)
- 2022-06-29
- 2022-07-05
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2022-07-12
Survey response — day 42, dose 4MedDRA: Diarrhoea — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Diarrhea 4+ times per day, for the last 3 days.MedDRA releases: 2024-11 · check-in free text available
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2022-08-30
Survey response — 3 months, dose 4MedDRA: Food poisoning, Salmonellosis — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Salmonella poisoning from JIF peanut butter.MedDRA releases: 2024-11 · check-in free text available
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2022-08-30
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-08-31
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-08-31
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-11-29
-
2023-05-31
Survey response — 12 months, dose 4MedDRA: Abdominal pain upper, Diarrhoea — Feeling: Fair · Be unable to do your normal daily activitiesMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-06 | Moderna | |
| 2 | 2021-02-08 | Moderna | |
| 3 | 2021-11-02 | Moderna | No |
| 4 | 2022-05-31 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-06-28 | Successful 2022-08-31 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-08-30 | Successful 2022-08-31 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 2 — day 21, dose 1
Symptoms: I have had a bad case of pericarditis before, and started getting the same symptoms on Jan 24. I started Ibuprofen 800 mg three times a day which was what my cardiologist put me on before. Symptoms are resolving now. I have an appt next week.
Release 5 — day 35, dose 2
Symptoms: My ears ring all the time, more noticeable every afternoon. Started more than a week ago but hasnt gone away.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Chest pain middle of chest
Release 12 — day 28, dose 4
Symptoms: Terrible sore throat, cough, headache, congestion, extreme fatigue, sneezing, dizziness, diarrhea, eyes burning
Release 12 — day 42, dose 4
Symptoms: Diarrhea 4+ times per day, for the last 3 days.
Release 12 — 3 months, dose 4
Symptoms: Salmonella poisoning from JIF peanut butter.
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 | Abdominal pain upper | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Dizziness | · | · | ✓ |
| SD | Eye irritation | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Food poisoning | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pericarditis | ✓ | ✓ | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Salmonellosis | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SD | Tinnitus | ✓ | ✓ | ✓ |
| SRO | Chest pain | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release