Z9F-10564-47281
5 vaccinations
8 coded responses
52 check-ins
7 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 112 / NY
- Registered
- 2021-01-19
- Relationship
- Self
- Race
- Multiracial
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-11
Dose 1 — Moderna
-
2021-01-19
Registered in v-safe
- 2021-01-19
- 2021-01-25
- 2021-02-01
-
2021-02-08
Dose 2 — Moderna
- 2021-02-08
-
2021-02-09
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
-
2021-02-10
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
- 2021-02-12
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-22
- 2021-03-01
- 2021-03-08
- 2021-03-15
- 2021-03-22
- 2021-05-12
- 2021-08-09
-
2021-10-29
Dose 3 — Moderna
-
2021-10-29
Health check-in — day 0, dose 3Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches · Be unable to do your normal daily activitiesAdult check-in
-
2021-10-30
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Nausea · Be unable to do your normal daily activitiesAdult check-in
-
2021-11-01
Survey response — days 1–6 daily, dose 3MedDRA: Insomnia — Feeling: Good · Site: PainFree text: Insomnia, probably unrelated. Difficulty falling and then staying asleep.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-02
- 2021-11-04
- 2021-11-05
- 2021-11-12
- 2021-11-19
- 2021-11-28
-
2021-12-03
Survey response — day 35, dose 3MedDRA: Impaired work ability, Oropharyngeal pain — Feeling: Good · Be unable to work or attend schoolFree text: Sore throat for a few days, seems to be resolving. Missed work out of caution, not because I was stuck in bed.MedDRA releases: 2024-11 · check-in free text available
- 2021-12-10
- 2022-01-28
- 2022-04-29
-
2022-05-13
Dose 4 — Moderna
- 2022-05-16
- 2022-05-18
- 2022-05-19
-
2022-05-20
Survey response — day 7, dose 4MedDRA: Oropharyngeal pain — Feeling: FairFree text: Sore throatMedDRA releases: 2024-11 · check-in free text available
-
2022-05-29
Survey response — day 14, dose 4MedDRA: Oropharyngeal pain, Sneezing — Feeling: GoodFree text: Sore throat/tonsils, sneezingMedDRA releases: 2024-11 · check-in free text available
- 2022-06-03
- 2022-06-10
-
2022-06-17
Survey response — day 35, dose 4MedDRA: Appetite disorder, Constipation, Cough, Diarrhoea, Fatigue, Headache, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test, Sneezing, Tonsillar hypertrophy — Feeling: Poor · 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: Symptoms: Sore throat, swollen tonsils with pus, headache, fatigue, sneezing, nasal congestion, cough, constipation, diarrhea, change in appetite. No fever. · Healthcare visit (other): COVID testing siteMedDRA releases: 2024-11 · check-in free text available
-
2022-06-17
Report sent to call center — day 35, dose 4Be 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)
- 2022-06-21
- 2022-06-26
- 2022-08-12
-
2022-10-12
Dose 5 — ModernaCo-administered: Flu
-
2022-10-15
Survey response — days 1–6 daily, dose 5MedDRA: Injection site pain — Feeling: Fair · Site: SwellingFree text: Soreness at injection siteMedDRA releases: 2024-11 · check-in free text available
- 2022-10-16
- 2022-10-17
- 2022-10-18
- 2022-10-19
- 2022-10-26
- 2022-11-02
- 2022-11-09
-
2022-11-16
Survey response — day 35, dose 5MedDRA: Oropharyngeal pain, Pain, SARS-CoV-2 test negative — Feeling: FairFree text: Just sore throat and general aches and pains but I don't think they're related. It's autumn and no positive COVID test.MedDRA releases: 2024-11 · check-in free text available
- 2022-11-24
- 2023-01-11
-
2023-04-12
Survey response — 6 months, dose 5MedDRA: COVID-19, Cough, Fatigue, Medical counselling, Oropharyngeal pain, SARS-CoV-2 test positive — 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 · Telehealth, virtual health, or email health consultationMedDRA releases: 2024-11
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2023-04-12
Report sent to call center — 6 months, dose 5Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2023-04-13
- 2023-04-13
- 2023-04-14
- 2023-04-14
-
2023-04-14
Callback requested for07:00PM ET
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-11 | Moderna | |
| 2 | 2021-02-08 | Moderna | |
| 3 | 2021-10-29 | Moderna | No |
| 4 | 2022-05-13 | Moderna | No |
| 5 | 2022-10-12 | Moderna | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-06-17 | Unsuccessful | |
| 2023-04-12 | Unsuccessful |
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Insomnia, probably unrelated. Difficulty falling and then staying asleep.
Release 10 — day 35, dose 3
Symptoms: Sore throat for a few days, seems to be resolving. Missed work out of caution, not because I was stuck in bed.
Release 11 — day 7, dose 4
Systemic reaction (other): Sore throat
Release 11 — day 14, dose 4
Symptoms: Sore throat/tonsils, sneezing
Release 12 — day 35, dose 4
Symptoms: Sore throat, swollen tonsils with pus, headache, fatigue, sneezing, nasal congestion, cough, constipation, diarrhea, change in appetite. No fever.
Healthcare visit (other): COVID testing site
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): Soreness at injection site
Release 12 — day 35, dose 5
Symptoms: Just sore throat and general aches and pains but I don't think they're related. It's autumn and no positive COVID test.
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 |
|---|---|---|---|---|
| HCVO | Medical counselling | · | · | ✓ |
| HCVO | SARS-CoV-2 test | · | · | ✓ |
| HCVO | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Appetite disorder | · | · | ✓ |
| SD | Constipation | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Impaired work ability | · | · | ✓ |
| SD | Nasal congestion | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SD | Tonsillar hypertrophy | · | · | ✓ |
| SRO | Injection site pain | · | · | ✓ |
| SRO | Insomnia | · | · | ✓ |
| SRO | Oropharyngeal pain | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release