4GV-14983-73983
3 vaccinations
6 coded responses
30 check-ins
6 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 115 / NY
- Registered
- 2021-01-11
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-11
Registered in v-safe
-
2021-01-11
Dose 1 — Moderna
- 2021-01-11
- 2021-01-13
- 2021-01-14
- 2021-01-25
- 2021-02-01
- 2021-02-08
-
2021-02-11
Dose 2 — Moderna
- 2021-02-15
- 2021-02-16
- 2021-02-18
- 2021-02-25
- 2021-03-04
- 2021-03-20
- 2021-03-25
- 2021-05-14
- 2021-08-12
-
2021-10-27
Dose 3 — Moderna
-
2021-10-27
Survey response — day 0, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
-
2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: Headache, Self-medication — Feeling: GoodFree text: Slight headache - that subsided with tylrniyMedDRA releases: 2024-11 · check-in free text available
- 2021-10-29
-
2021-10-30
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
-
2021-11-01
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event, Pre-existing disease — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: I was in a car accident 10/30/21 so I don't feel great due to that - mostly my left side and headache back shoulder ( I saw a Dr) my point - it's not Covid booster related , that, in my R arm, I feel fine. Have had no adverse reactions frombooster-txMedDRA releases: 2024-11 · check-in free text available
-
2021-11-02
Survey response — days 1–6 daily, dose 3MedDRA: Pain, Road traffic accident — Feeling: Good · Be unable to work or attend schoolFree text: Pain on left side secondary to car accident (someone T- Boned me).MedDRA releases: 2024-11 · check-in free text available
-
2021-11-04
Survey response — day 7, dose 3MedDRA: Adverse reaction, Road traffic accident — 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 · Outpatient clinic or urgent care clinic visitFree text: I have symptoms but they are on left side secondary and only after aa car accident which came after my vaccination up until car accident no symptoms anywhereMedDRA releases: 2024-11 · check-in free text available
-
2021-11-04
Report sent to call center — day 7, dose 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)
- 2021-11-05
- 2021-11-11
- 2021-11-17
- 2021-11-24
- 2021-12-01
- 2021-12-08
- 2022-01-26
- 2022-04-27
- 2022-10-27
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-11 | Moderna | |
| 2 | 2021-02-11 | Moderna | |
| 3 | 2021-10-27 | Moderna | No |
Call center
1 call center case
1 unsuccessful
Free text
Release 10 — day 0, dose 3
Systemic reaction (other): No
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Slight headache - that subsided with tylrniy
Systemic reaction (other): No
Systemic reaction (other): I was in a car accident 10/30/21 so I don't feel great due to that - mostly my left side and headache back shoulder ( I saw a Dr) my point - it's not Covid booster related , that, in my R arm, I feel fine. Have had no adverse reactions frombooster-tx cut off by CDC
Systemic reaction (other): Pain on left side secondary to car accident (someone T- Boned me).
Release 10 — day 7, dose 3
Systemic reaction (other): I have symptoms but they are on left side secondary and only after aa car accident which came after my vaccination up until car accident no symptoms anywhere
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 | Adverse reaction | · | · | ✓ |
| SRO | Headache | · | · | ✓ |
| SRO | No adverse event | · | · | ✓ |
| SRO | Pain | · | · | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
| SRO | Road traffic accident | · | · | ✓ |
| SRO | Self-medication | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release