338-14057-64039
4 vaccinations
3 coded responses
23 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 31-35
- ZIP prefix
- 913 / CA
- Registered
- 2021-02-11
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Registered dependents
JMU-12712-66867
Child or adolescent in my care · Male · 2022-09-30
KU6-13788-92437
Child or adolescent in my care · Male · 2023-02-18
Timeline
-
2020-12-17
Dose 1 — Pfizer-BioNTech
-
2021-01-07
Dose 2 — Pfizer-BioNTech
-
2021-02-11
Registered in v-safe
- 2021-02-11
- 2021-02-18
- 2021-04-10
- 2021-07-10
-
2021-09-30
Dose 3 — Pfizer-BioNTech
-
2021-10-02
Survey response — days 1–6 daily, dose 3MedDRA: Injection site pain — Feeling: GoodFree text: Sore Arm at Injection SiteMedDRA releases: 2024-11 · check-in free text available
- 2021-10-03
- 2021-10-04
- 2021-10-05
- 2021-10-07
- 2021-10-14
-
2021-10-21
Survey response — day 21, dose 3MedDRA: Nasopharyngitis — Feeling: GoodFree text: I had a coldMedDRA releases: 2024-11 · check-in free text available
- 2021-10-28
- 2021-11-04
- 2021-11-11
- 2021-12-30
-
2022-03-31
Survey response — 6 months, dose 3MedDRA: Caesarean section, Live birth — Feeling: Good · Get care from a doctor or other healthcare professional · HospitalizationFree text: Symptoms: I gave birth to a healthy baby boy. · Healthcare visit (other): C-sectionMedDRA releases: 2024-11 · check-in free text available
-
2022-03-31
Report sent to call center — 6 months, dose 3Get care from a doctor or other healthcare professionalHospitalization · 1 call case(s)
-
2022-04-05
Call successfulDoes not wish to fill out VAERS report
-
2022-09-09
Dose 4 — Moderna
- 2022-09-30
- 2022-09-30
- 2022-10-07
- 2022-10-14
- 2022-10-21
- 2022-12-09
- 2023-03-10
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-17 | Pfizer-BioNTech | |
| 2 | 2021-01-07 | Pfizer-BioNTech | |
| 3 | 2021-09-30 | Pfizer-BioNTech | No |
| 4 | 2022-09-09 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-03-31 | Successful 2022-04-05 |
Does not wish to fill out VAERS report |
Free text
Release 9 — days 1–6 daily, dose 3
Systemic reaction (other): Sore Arm at Injection Site
Release 10 — day 21, dose 3
Symptoms: I had a cold
Release 11 — 6 months, dose 3
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 | Caesarean section | · | · | ✓ |
| SD | Live birth | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SRO | Injection site pain | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release