57R-16456-50332
2 vaccinations
3 coded responses
24 check-ins
2 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 0-4
- ZIP prefix
- 801 / CO
- Registered
- 2022-06-22
- Relationship
- Child or adolescent in my care
- Guardian
- Z93-22698-33950
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2022-06-22
Registered in v-safe
-
2022-06-22
Dose 1 — Moderna
- 2022-06-22
-
2022-06-23
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Fair · Site: Pain · Headache, Muscle or body achesAdult check-in
- 2022-06-24
-
2022-06-25
Survey response — days 1–6 daily, dose 1, dependentMedDRA: Lip swelling — Feeling: GoodFree text: Upper lip swelling- potential environmental allergiesMedDRA releases: 2024-11 · check-in free text available
- 2022-06-26
- 2022-06-28
-
2022-06-29
Health check-in — day 7, dose 1, dependentFeeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
- 2022-07-06
- 2022-07-13
-
2022-07-20
Dose 2 — Moderna
- 2022-07-20
-
2022-07-21
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Good · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2022-07-22
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2022-07-23
- 2022-07-24
- 2022-07-25
- 2022-07-26
- 2022-07-27
- 2022-08-05
- 2022-08-10
-
2022-08-17
Survey response — day 28, dose 2, dependentMedDRA: Cough, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative, Swelling face, Swelling of eyelid — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Congestion and runny nose. Cough. Swollen face especially eyelids. Negative rapid Covid test.MedDRA releases: 2024-11 · check-in free text available
-
2022-08-17
Report sent to call center — day 28, dose 2, dependentGet care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-08-18
- 2022-08-24
- 2022-08-31
- 2022-10-19
-
2023-01-19
Survey response — 6 months, dose 2, dependentMedDRA: Gastroenteritis viral, Headache, Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activitiesMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2022-06-22 | Moderna | No |
| 2 | 2022-07-20 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-08-17 | Unsuccessful |
Free text
Release 12 — days 1–6 daily, dose 1, dependent
Systemic reaction (other): Upper lip swelling- potential environmental allergies
Release 12 — day 28, dose 2, dependent
Symptoms: Congestion and runny nose. Cough. Swollen face especially eyelids. Negative rapid 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 |
|---|---|---|---|---|
| SD | Cough | · | · | ✓ |
| SD | Gastroenteritis viral | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Swelling face | · | · | ✓ |
| SD | Swelling of eyelid | · | · | ✓ |
| SRO | Lip swelling | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release