24E-18691-23051
2 vaccinations
5 coded responses
18 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 12-15
- ZIP prefix
- 018 / MA
- Registered
- 2021-10-24
- Relationship
- Child or adolescent in my care
- Guardian
- YY5-55135-88297
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-10-24
Registered in v-safe
-
2021-10-24
Dose 1 — Pfizer-BioNTech
-
2021-10-24
Survey response — day 0, dose 1, dependentMedDRA: Eye pain, Vision blurred — Feeling: Fair · Site: Swelling · Chills, Fatigue or tirednessFree text: Eyes hurt and blurryMedDRA releases: 2024-11 · check-in free text available
-
2021-10-25
Survey response — days 1–6 daily, dose 1, dependentMedDRA: Dizziness, Eye pain, Headache, Neck pain, Pain in extremity, Vision blurred — Feeling: Poor · Site: Pain, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend schoolFree text: Pain in the hands to the arm towards the neck radiates to the head causing headaces to the head and eye , dizziness , blur visionMedDRA releases: 2024-11 · check-in free text available
-
2021-10-26
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Fair · Site: Itching · Headache, Joint pains, Muscle or body aches, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
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2021-10-27
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Fair · Site: Itching · Chills, Headache, Joint pains, Muscle or body achesAdult check-in
-
2021-10-29
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Fair · Site: Itching · Chills, Headache, Joint pains, Muscle or body achesAdult check-in
-
2021-10-30
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Fair · Site: Itching · Chills, Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-10-31
-
2021-11-08
Survey response — day 14, dose 1, dependentMedDRA: Fatigue, Headache, Pain — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Headaches, tiredness, body achesMedDRA releases: 2024-11 · check-in free text available
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2021-11-14
Dose 2 — Pfizer-BioNTech
-
2021-11-14
Health check-in — day 0, dose 2, dependentFeeling: Poor · Site: Itching · Headache, Fatigue or tirednessAdult check-in
-
2021-11-15
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Fair · Site: Pain, Itching · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-11-16
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Poor · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-11-19
- 2021-11-28
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2021-12-05
Survey response — day 21, dose 2, dependentMedDRA: Eczema, Headache, Office visit, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Eczema flare up on both arm pits , headaches · Healthcare visit (other): In person check upMedDRA releases: 2024-11 · check-in free text available
-
2021-12-05
Report sent to call center — day 21, dose 2, dependentGet care from a doctor or other healthcare professional1 call case(s)
- 2021-12-09
- 2021-12-15
-
2021-12-19
Survey response — day 35, dose 2, dependentMedDRA: Headache — Feeling: Good · Be unable to do your normal daily activitiesFree text: HeadacheMedDRA releases: 2024-11 · check-in free text available
- 2021-12-26
- 2022-05-18
- 2022-11-16
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-10-24 | Pfizer-BioNTech | No |
| 2 | 2021-11-14 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-12-05 | Unsuccessful |
Free text
Release 10 — day 0, dose 1, dependent
Systemic reaction (other): Eyes hurt and blurry
Release 10 — days 1–6 daily, dose 1, dependent
Systemic reaction (other): Pain in the hands to the arm towards the neck radiates to the head causing headaces to the head and eye , dizziness , blur vision
Release 10 — day 14, dose 1, dependent
Symptoms: Headaches, tiredness, body aches
Release 10 — day 21, dose 2, dependent
Symptoms: Eczema flare up on both arm pits , headaches
Healthcare visit (other): In person check up
Release 10 — day 35, dose 2, dependent
Symptoms: Headache
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 | Office visit | · | · | ✓ |
| SD | Eczema | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SRO | Dizziness | · | · | ✓ |
| SRO | Eye pain | · | · | ✓ |
| SRO | Headache | · | · | ✓ |
| SRO | Neck pain | · | · | ✓ |
| SRO | Pain in extremity | · | · | ✓ |
| SRO | Vision blurred | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release