4XW-21080-04069
3 vaccinations
6 coded responses
21 check-ins
5 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 51-55
- ZIP prefix
- 982 / WA
- Registered
- 2021-05-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-05-02
Dose 1 — Moderna
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2021-05-04
Registered in v-safe
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2021-05-04
Survey response — days 1–6 daily, dose 1MedDRA: Fatigue, Pain, Pre-existing disease — Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tirednessFree text: The fatigue is a bit more than normal, but the other symptoms are part of the chronic pain I live with and I don attribute them to the vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-05
Survey response — days 1–6 daily, dose 1MedDRA: Arthralgia, Joint swelling, Pain in extremity, Pre-existing disease — Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tirednessFree text: again these are chronic and do not appear to be related to the vaccine. swelling of the shoulder is down and less pain in the arm and shoulderMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-06
Survey response — days 1–6 daily, dose 1MedDRA: Adverse reaction — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal painFree text: I experience all the symtoms periodically with my chronic issuesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-08
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-05-11
Health check-in — day 7, dose 1Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-05-18
- 2021-05-23
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2021-05-31
Dose 2 — Moderna
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2021-06-01
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
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2021-06-02
Survey response — days 1–6 daily, dose 2MedDRA: Constipation — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesFree text: constipationMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-03
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Abdominal painAdult check-in
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2021-06-06
Survey response — days 1–6 daily, dose 2MedDRA: Adverse reaction — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal painFree text: these are around 'normal' pre shot levelsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-07
Health check-in — day 7, dose 2Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-06-14
- 2021-06-21
- 2021-06-30
- 2021-07-05
- 2021-07-12
- 2021-09-01
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2022-02-13
Dose 3 — Moderna
- 2022-05-16
- 2022-08-21
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2023-02-15
Survey response — 12 months, dose 3MedDRA: Influenza, Nasopharyngitis — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-05-02 | Moderna | |
| 2 | 2021-05-31 | Moderna | |
| 3 | 2022-02-13 | Moderna | No |
Free text
Release 8 — days 1–6 daily, dose 1
Systemic reaction (other): The fatigue is a bit more than normal, but the other symptoms are part of the chronic pain I live with and I don attribute them to the vaccine
Systemic reaction (other): again these are chronic and do not appear to be related to the vaccine. swelling of the shoulder is down and less pain in the arm and shoulder
Systemic reaction (other): I experience all the symtoms periodically with my chronic issues
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): constipation
Systemic reaction (other): these are around 'normal' pre shot levels
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 | Influenza | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SRO | Adverse reaction | ✓ | ✓ | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Constipation | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Joint swelling | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ○ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release