Originally a depiction of Madotsuki from Yume Nikki attempting to contain her vomit, drawn by Aosora (Mizore)

The drawing has been often used as a reaction image on imageboards to express disgust towards someone's opinion or facts, in addition to its use as exploitable template. As popularity of the image grew, the nickname "Vomit-Chan" was used over Madotsuki, sometimes replacing the name. The original image inspired derivates, all as a reaction to portray extreme dismay or disgust.

The image was also referenced in Doki Doki Literature Club, where Natsuki reacted the same way.

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