4VQ-11216-26201
3 vaccinations
16 coded responses
39 check-ins
16 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 31-35
- ZIP prefix
- 030 / NH
- Registered
- 2021-04-11
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-04-10
Dose 1 — Moderna
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2021-04-11
Registered in v-safe
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2021-04-11
Survey response — days 1–6 daily, dose 1MedDRA: Musculoskeletal chest pain — Feeling: Fair · Site: Pain · Muscle or body aches, DiarrheaFree text: Chest wall painMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-12
Survey response — days 1–6 daily, dose 1MedDRA: Cough, Throat irritation — Feeling: GoodFree text: Scratchy throat causing occasional coughMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-13
Survey response — days 1–6 daily, dose 1MedDRA: Cough — Feeling: GoodFree text: CoughMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-14
Survey response — days 1–6 daily, dose 1MedDRA: Cough, SARS-CoV-2 test negative — Feeling: FairFree text: Cough. Negative covid test.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-15
Survey response — days 1–6 daily, dose 1MedDRA: Cough — Feeling: FairFree text: CoughMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-16
Survey response — days 1–6 daily, dose 1MedDRA: Cough — Feeling: FairFree text: CoughMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-17
Survey response — day 7, dose 1MedDRA: Cough — Feeling: FairFree text: CoughMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-24
- 2021-05-01
- 2021-05-08
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2021-05-09
Dose 2 — Moderna
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2021-05-10
Survey response — days 1–6 daily, dose 2MedDRA: Cough — Feeling: Good · Site: Pain · Headache, Muscle or body achesFree text: Still coughing since 4/12/21 (2 days after my first shot)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-11
Survey response — days 1–6 daily, dose 2MedDRA: Injection site swelling — Feeling: Fair · Site: Pain · HeadacheFree text: Small bump at injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-12
Survey response — days 1–6 daily, dose 2MedDRA: Injection site mass — Feeling: Fair · Site: Pain · HeadacheFree text: Lump at injection site, not raised much but about 2"-3" wideMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-13
Survey response — days 1–6 daily, dose 2MedDRA: Injection site mass — Feeling: Good · Site: Pain · HeadacheFree text: Lump at injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-14
Survey response — days 1–6 daily, dose 2MedDRA: Injection site mass — Feeling: GoodFree text: Still have a lump at injection site but no painMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-15
Survey response — days 1–6 daily, dose 2MedDRA: Migraine with aura — Feeling: Fair · Site: Itching · HeadacheFree text: Migraine with auraMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-16
- 2021-05-23
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2021-05-31
Survey response — day 21, dose 2MedDRA: Ear pruritus, Nasal congestion, Rhinorrhoea — Feeling: FairFree text: Possible allergies - itchy ears, runny/congested noseMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-06-06
- 2021-06-13
- 2021-06-21
- 2021-08-08
- 2021-11-07
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2021-12-22
Dose 3 — Moderna
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2021-12-23
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
- 2021-12-24
- 2021-12-25
- 2021-12-26
- 2021-12-27
- 2021-12-28
- 2021-12-29
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2022-01-05
Survey response — day 14, dose 3MedDRA: Nasopharyngitis, SARS-CoV-2 test negative — Feeling: FairFree text: Cold symptoms, negative rapid covid tests x2MedDRA releases: 2024-11 · check-in free text available
- 2022-01-12
- 2022-01-19
- 2022-01-26
- 2022-02-02
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2022-03-25
Survey response — 3 months, dose 3MedDRA: Cough, Respiratory tract congestion, Rhinorrhoea, Self-medication — 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: Cough, runny nose, congestion most of March. Very bad cough until it was treated with Flonase and Azelastine. Tessalon pearls cough medicine didn't give much relief at all.MedDRA releases: 2024-11 · check-in free text available
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2022-03-25
Report sent to call center — 3 months, 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)
- 2022-03-28
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2022-03-29
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-06-22
- 2022-12-22
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-10 | Moderna | |
| 2 | 2021-05-09 | Moderna | |
| 3 | 2021-12-22 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 7 — days 1–6 daily, dose 1
Systemic reaction (other): Chest wall pain
Systemic reaction (other): Scratchy throat causing occasional cough
Systemic reaction (other): Cough
Systemic reaction (other): Cough. Negative covid test.
Systemic reaction (other): Cough
Systemic reaction (other): Cough
Release 7 — day 7, dose 1
Systemic reaction (other): Cough
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): Still coughing since 4/12/21 (2 days after my first shot)
Systemic reaction (other): Small bump at injection site
Systemic reaction (other): Lump at injection site, not raised much but about 2"-3" wide
Systemic reaction (other): Lump at injection site
Systemic reaction (other): Still have a lump at injection site but no pain
Systemic reaction (other): Migraine with aura
Release 8 — day 21, dose 2
Symptoms: Possible allergies - itchy ears, runny/congested nose
Release 10 — day 14, dose 3
Symptoms: Cold symptoms, negative rapid covid tests x2
Release 11 — 3 months, dose 3
Symptoms: Cough, runny nose, congestion most of March. Very bad cough until it was treated with Flonase and Azelastine. Tessalon pearls cough medicine didn't give much relief at all.
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 | Cough | · | · | ✓ |
| SD | Ear pruritus | ✓ | ✓ | ✓ |
| SD | Nasal congestion | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Rhinorrhoea | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Self-medication | · | · | ✓ |
| SRO | Cough | ✓ | ✓ | ✓ |
| SRO | Injection site mass | ✓ | ✓ | ✓ |
| SRO | Injection site swelling | ✓ | ✓ | ✓ |
| SRO | Migraine with aura | ✓ | ✓ | ✓ |
| SRO | Musculoskeletal chest pain | ✓ | ✓ | ✓ |
| SRO | SARS-CoV-2 test negative | ✓ | ✓ | ✓ |
| SRO | Throat irritation | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release