2L9-17553-29460
5 vaccinations
6 coded responses
32 check-ins
6 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 288 / NC
- Registered
- 2021-01-27
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-27
Registered in v-safe
-
2021-01-27
Dose 1 — Pfizer-BioNTech
- 2021-01-27
-
2021-01-28
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-01-29
-
2021-01-30
Survey response — days 1–6 daily, dose 1MedDRA: Pruritus, Rash — Feeling: Fair · Rash, not including the immediate area around the injection siteFree text: Slight rash and itchiness on my legs last nightMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-31
Survey response — days 1–6 daily, dose 1MedDRA: Pruritus — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: Still have itchiness on my legsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-01
Survey response — days 1–6 daily, dose 1MedDRA: Rash, Rash pruritic, Self-medication — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: Still have rash on legs. But it is less itchy. Have taken Benadryl last two nightsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-02
Health check-in — days 1–6 daily, dose 1Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
-
2021-02-03
Survey response — day 7, dose 1MedDRA: Unevaluable event — Feeling: Fair · Rash, not including the immediate area around the injection site · Be unable to do your normal daily activitiesFree text: Still have on legsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-10
-
2021-02-17
Dose 2 — Pfizer-BioNTech
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-20
- 2021-02-21
- 2021-02-22
- 2021-02-23
- 2021-02-24
- 2021-03-03
- 2021-03-10
- 2021-03-17
- 2021-03-24
- 2021-03-31
- 2021-05-19
-
2021-08-18
Survey response — 6 months, dose 2MedDRA: Cholecystectomy, Polyp, Surgery, Testicular cyst — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Had gall bladder removed because of polyps. Cyst in one testicle. But nothing covid or vaccine related. · Healthcare visit (other): Outpatient surgeryMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-18
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-25
-
2021-08-25
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-09-23
Dose 3 — Pfizer-BioNTech
- 2022-02-17
-
2022-04-05
Dose 4 — Pfizer-BioNTech
-
2022-09-10
Dose 5 — Moderna
- 2022-09-23
- 2022-09-24
- 2022-10-02
-
2022-10-16
Survey response — day 35, dose 5MedDRA: COVID-19, Illness — Feeling: GoodFree text: After receiving my 4th shot in April, I caught Covid in May, 2022. I fully recovered and have now received a 5th shot. I have no problems now. My illness occurred when I was not receiving notices to check-in. I thought you should know.MedDRA releases: 2024-11 · check-in free text available
- 2022-10-22
- 2022-12-10
- 2023-03-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-27 | Pfizer-BioNTech | |
| 2 | 2021-02-17 | Pfizer-BioNTech | |
| 3 | 2021-09-23 | Pfizer-BioNTech | No |
| 4 | 2022-04-05 | Pfizer-BioNTech | No |
| 5 | 2022-09-10 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): Slight rash and itchiness on my legs last night
Systemic reaction (other): Still have itchiness on my legs
Systemic reaction (other): Still have rash on legs. But it is less itchy. Have taken Benadryl last two nights
Release 3 — day 7, dose 1
Systemic reaction (other): Still have on legs
Release 9 — 6 months, dose 2
Symptoms: Had gall bladder removed because of polyps. Cyst in one testicle. But nothing covid or vaccine related.
Healthcare visit (other): Outpatient surgery
Release 12 — day 35, dose 5
Symptoms: After receiving my 4th shot in April, I caught Covid in May, 2022. I fully recovered and have now received a 5th shot. I have no problems now. My illness occurred when I was not receiving notices to check-in. I thought you should know.
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 | Surgery | ✓ | · | ✓ |
| SD | Cholecystectomy | ✓ | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Illness | · | · | ✓ |
| SD | Polyp | ✓ | · | ✓ |
| SD | Testicular cyst | ✓ | · | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
| SRO | Rash | ✓ | ✓ | ✓ |
| SRO | Rash pruritic | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release