4AY-13493-10539
2 vaccinations
5 coded responses
25 check-ins
5 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 458 / OH
- Registered
- 2020-12-29
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-29
Registered in v-safe
-
2020-12-30
Dose 1 — Moderna
-
2020-12-30
Survey response — day 0, dose 1MedDRA: Incorrect route of product administration, Injection site pain — Feeling: Good · Site: PainFree text: Having injection site pain bc vaccine administered too high near shoulder instead of properly into deltoid muscleMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2020-12-31
Survey response — days 1–6 daily, dose 1MedDRA: Administration site joint pain, Product administered at inappropriate site — Feeling: Good · Site: Pain · Headache, Joint painsFree text: Joint pain is only in left shoulder where vaccine was incorrectly administer (NOT correctly into deltoid muscle, but unfortunately too high and into shoulder area, hoping no long term damage like SIRVA)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-02
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain, Product administered at inappropriate site — Feeling: Good · Site: PainFree text: Pain of incorrect injection site lessening today thank goodnessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-03
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: GoodFree text: Injection site feeing better thankfully (pain due to incorrect site)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-04
- 2021-01-05
- 2021-01-06
- 2021-01-13
- 2021-01-20
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2021-01-27
Dose 2 — Moderna
- 2021-01-27
-
2021-01-28
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness — Feeling: Poor · Site: Pain · Headache, Fatigue or tiredness, Nausea, DiarrheaFree text: DizzinessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-29
- 2021-01-30
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-10
- 2021-02-17
- 2021-02-24
- 2021-03-03
- 2021-03-10
- 2021-04-28
- 2021-07-29
- 2022-01-27
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-30 | Moderna | |
| 2 | 2021-01-27 | Moderna |
Free text
Release 1 — day 0, dose 1
Systemic reaction (other): Having injection site pain bc vaccine administered too high near shoulder instead of properly into deltoid muscle
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): Joint pain is only in left shoulder where vaccine was incorrectly administer (NOT correctly into deltoid muscle, but unfortunately too high and into shoulder area, hoping no long term damage like SIRVA)
Systemic reaction (other): Pain of incorrect injection site lessening today thank goodness
Systemic reaction (other): Injection site feeing better thankfully (pain due to incorrect site)
Release 2 — days 1–6 daily, dose 2
Systemic reaction (other): Dizziness
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 |
|---|---|---|---|---|
| SRO | Administration site joint pain | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Incorrect route of product administration | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Product administered at inappropriate site | ✓ | ✓ | ✓ |
| SRO | Wrong technique in product usage process | ○ | ○ | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release