Z6X-14481-75964
1 vaccination
8 coded responses
15 check-ins
8 free-text entries
4 call cases
- Sex
- Male
- Age at first dose
- 46-50
- ZIP prefix
- 551 / MN
- Registered
- 2021-04-06
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-04-06
Registered in v-safe
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2021-04-06
Dose 1 — Moderna
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2021-04-06
Survey response — day 0, dose 1MedDRA: Lip swelling — Feeling: Poor · Site: Pain, Swelling, Itching · Headache, Joint pains, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activitiesFree text: Lip swellingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-07
Survey response — days 1–6 daily, dose 1MedDRA: Emergency care, Lip swelling — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Muscle or body aches · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Lip swelling i went to regions emergency room they gave me a shotMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-07
Report sent to call center — days 1–6 daily, dose 1Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-08
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to do your normal daily activitiesAdult check-in
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2021-04-09
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Nausea, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
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2021-04-10
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Swelling, Itching · Chills, Headache, Muscle or body aches, Nausea · Be unable to do your normal daily activitiesAdult check-in
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2021-04-11
Health check-in — days 1–6 daily, dose 1Feeling: Poor · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
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2021-04-12
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Muscle or body achesAdult check-in
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2021-04-13
Health check-in — day 7, dose 1Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches · Be unable to do your normal daily activitiesAdult check-in
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2021-04-20
Survey response — day 14, dose 1MedDRA: Chills, Headache, Nasopharyngitis — Feeling: Fair · Be unable to do your normal daily activitiesFree text: HeadachesHot and cold chillsAwful taste buds Feels like im im gonna get sickMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-27
Survey response — day 21, dose 1MedDRA: Genital swelling, Penile swelling — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Swollen penisMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-06
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2021-05-13
Survey response — day 35, dose 1MedDRA: Abdominal pain upper, Arthralgia, Feeding disorder, Tongue coated — Feeling: Poor · Be unable to work, 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: Sores in headWhite stain on tongueSharp knee painStomach painHave not eat solid food in 7 daysMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-13
Report sent to call center — day 35, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-07-06
Survey response — 3 months, dose 1MedDRA: Decreased appetite, Rash — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Bumps in headLess appetiteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-10-07
Survey response — 6 months, dose 1MedDRA: Abdominal distension, Constipation, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Constipation and bloating for over 2 months. I went to doctors and the medicine given did not work at all. I need helpMedDRA releases: 2024-11 · check-in free text available
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2021-10-07
Report sent to call center — 6 months, dose 1Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2021-10-08
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2022-04-10
Survey response — 12 months, dose 1MedDRA: Adverse reaction, Ageusia, Gait disturbance, Office visit, Pain in extremity, Skin discolouration, Walking aid user — 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 professionalFree text: Symptoms: I can not walk without a cane. I have to hold rails when i enter any building. When i take baths both feet hurt badly along with both legs. I got no taste bud in my mouth. Everything is bland. My hands are so black now.my hands are so black now. · Healthcare visit (other): Went to primary doctor at (b)(6) Hospital to inform them of reactions.MedDRA releases: 2024-11 · check-in free text available
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2022-04-10
Report sent to call center — 12 months, dose 1Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
- 2022-04-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-06 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-04-07 | Unsuccessful | |
| 2021-05-13 | Unsuccessful | |
| 2021-10-07 | Unsuccessful | |
| 2022-04-10 | Unsuccessful |
Free text
Release 7 — day 0, dose 1
Systemic reaction (other): Lip swelling
Release 7 — days 1–6 daily, dose 1
Systemic reaction (other): Lip swelling i went to regions emergency room they gave me a shot
Release 7 — day 14, dose 1
Symptoms: HeadachesHot and cold chillsAwful taste buds Feels like im im gonna get sick
Release 8 — day 21, dose 1
Symptoms: Swollen penis
Release 8 — day 35, dose 1
Symptoms: Sores in headWhite stain on tongueSharp knee painStomach painHave not eat solid food in 7 days
Release 9 — 3 months, dose 1
Symptoms: Bumps in headLess appetite
Release 10 — 6 months, dose 1
Symptoms: Constipation and bloating for over 2 months. I went to doctors and the medicine given did not work at all. I need help
Release 11 — 12 months, dose 1
Symptoms: I can not walk without a cane. I have to hold rails when i enter any building. When i take baths both feet hurt badly along with both legs. I got no taste bud in my mouth. Everything is bland. My hands are so black now.my hands are so black now.
Healthcare visit (other): Went to primary doctor at (b)(6) Hospital to inform them of reactions.
redacted (b)(6)
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 | Adverse reaction | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| SD | Abdominal distension | · | · | ✓ |
| SD | Abdominal pain upper | ✓ | ✓ | ✓ |
| SD | Ageusia | · | · | ✓ |
| SD | Arthralgia | ✓ | ✓ | ✓ |
| SD | Chills | ✓ | ✓ | ✓ |
| SD | Constipation | · | · | ✓ |
| SD | Decreased appetite | ✓ | ✓ | ✓ |
| SD | Feeding disorder | ✓ | ✓ | ✓ |
| SD | Gait disturbance | · | · | ✓ |
| SD | Genital swelling | ○ | ✓ | ○ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | ✓ | ✓ | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Penile swelling | ✓ | · | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SD | Skin discolouration | · | · | ✓ |
| SD | Tongue coated | ✓ | ✓ | ✓ |
| SD | Walking aid user | · | · | ✓ |
| SRO | Emergency care | ✓ | ✓ | ✓ |
| SRO | Lip swelling | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release