2AY-27721-56465

2 vaccinations 8 coded responses 22 check-ins 8 free-text entries 3 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 123 / NY
Registered: 2021-02-20

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-02-19
Dose 1 — Pfizer-BioNTech
2021-02-20
Registered in v-safe
2021-02-20
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site bruising, Injection site pain — Feeling: Good · Fatigue or tiredness

Free text: Mild bruising ( size of small apple) at injection site, with mild soreness. Had stopped Elequis as ordered 5 days prior to vaccination.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Survey response — days 1–6 daily, dose 1
MedDRA: Anxiety, Feeling jittery, Insomnia — Feeling: Good · Fatigue or tiredness

Free text: Jittery, anxious, difficulty slerping

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — days 1–6 daily, dose 1
MedDRA: Insomnia, Restlessness — Feeling: Good · Fatigue or tiredness, Diarrhea

Free text: Restlessness, insomnia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-28
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-05
Survey response — day 14, dose 1
MedDRA: Cardiac failure congestive, Dyspnoea, Fatigue — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Chf, fatigue,shortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-12
Dose 2 — Pfizer-BioNTech
2021-03-12
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-02
Survey response — day 21, dose 2
MedDRA: Diarrhoea haemorrhagic, Gastrointestinal pain, Medical counselling — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: GI cramping, Bloody diarrhea started 3/27, dx as C Diff. on 3/30. Febrile to 103 x 3 days. Some improvement today , afebrile, on vancomycin qid. · Healthcare visit (other): In home visit VNA, and telephone conf with PMD

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-09
Survey response — day 28, dose 2
MedDRA: Clostridium difficile colitis, Clostridium difficile infection, Hospice care — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: C. Difficeal. · Healthcare visit (other): Now on Hospice

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-16
Survey response — day 35, dose 2
MedDRA: Clostridium difficile colitis, Clostridium difficile infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: C. Difficeal

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-11
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-12
Survey response — 6 months, dose 2
MedDRA: Cardiac failure congestive, Death, Pulmonary hypertension — Feeling: Poor

Free text: He passed away in May 2021 CHF and pulmonary HTN

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-19	Pfizer-BioNTech
2	2021-03-12	Pfizer-BioNTech

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-20

Systemic reaction (other): Mild bruising ( size of small apple) at injection site, with mild soreness. Had stopped Elequis as ordered 5 days prior to vaccination.

2021-02-21

Systemic reaction (other): Jittery, anxious, difficulty slerping

2021-02-22

Systemic reaction (other): Restlessness, insomnia

Release 5 — day 14, dose 1

2021-03-05

Symptoms: Chf, fatigue,shortness of breath

Release 6 — day 21, dose 2

2021-04-02

Symptoms: GI cramping, Bloody diarrhea started 3/27, dx as C Diff. on 3/30. Febrile to 103 x 3 days. Some improvement today , afebrile, on vancomycin qid.

Healthcare visit (other): In home visit VNA, and telephone conf with PMD

Release 7 — day 28, dose 2

2021-04-09

Symptoms: C. Difficeal.

Healthcare visit (other): Now on Hospice

Release 7 — day 35, dose 2

2021-04-16

Symptoms: C. Difficeal

Release 9 — 6 months, dose 2

Reports this person's death

2021-09-12

Symptoms: He passed away in May 2021 CHF and pulmonary HTN

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	Hospice care	✓	✓	✓
HCVO	Medical counselling	✓	✓	✓
SD	Cardiac failure congestive	·	·	✓
SD	Clostridium difficile colitis	✓	✓	○
SD	Clostridium difficile infection	✓	·	✓
SD	Death	·	·	✓
SD	Diarrhoea haemorrhagic	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gastrointestinal pain	✓	✓	✓
SD	Pulmonary hypertension	·	·	✓
SRO	Anxiety	✓	✓	✓
SRO	Feeling jittery	✓	✓	✓
SRO	Injection site bruising	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Restlessness	✓	✓	✓

✓ active code · ○ coded but marked inactive · blank = not in that release