6JV-40493-04474
1 vaccination
2 coded responses
6 check-ins
2 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 641 / MO
- Registered
- 2021-08-20
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-08-20
Registered in v-safe
-
2021-08-20
Dose 1 — Moderna
-
2021-08-21
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-08-22
- 2021-08-23
- 2021-08-24
-
2021-09-03
Survey response — day 14, dose 1MedDRA: Emergency care — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: ER VisitMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-09-03
Report sent to call center — day 14, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-09
-
2021-09-10
Survey response — day 21, dose 1MedDRA: COVID-19 — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: I was diagnosed covid positive on Sept 3rd been experiencing all negative covid symptoms sinceMedDRA releases: 2024-11 · check-in free text available
-
2021-09-10
Report sent to call center — day 21, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-08-20 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-09-03 | Unsuccessful | |
| 2021-09-10 | Unsuccessful |
Free text
Release 9 — day 14, dose 1
Symptoms: ER Visit
Release 9 — day 21, dose 1
Symptoms: I was diagnosed covid positive on Sept 3rd been experiencing all negative covid symptoms since
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 | COVID-19 | · | · | ✓ |
| SD | Emergency care | ✓ | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release