36R-27991-80876 · OpenVSafe

Timeline

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

2021-03-14
Dose 1 — Pfizer-BioNTech
2021-03-18
Registered in v-safe
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Fair

Free text: I have an ongoing medical condition with some similar symptoms. I do not think they are at all related to the Covid-19 vaccine I recently had. The symptoms haven't changed after the shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease, Unevaluable event — Feeling: Fair · Site: Pain · Fatigue or tiredness, Diarrhea, Abdominal pain

Free text: These are ongoing and associated with a medical condition, not with the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-15
Survey response — 3 months, dose 1
MedDRA: Death, Pre-existing disease, Surgery — 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 professional · Hospitalization

Free text: (b)(6) died 4/21/21. During a surgical procedure. Non COVID related other than prolonging surgery due to lack of hospital availability for non COVID illnesses.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-15
Report sent to call center — 3 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-06-23
Call 1 — Left Voicemail
2021-07-08
Call successful
Other
2021-09-12
Survey response — 6 months, dose 1
MedDRA: Death, Unevaluable event — 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 professional · Hospitalization

Free text: Symptoms: Died 4.21.2021. Already provided this information. Not COVID related other than perhaps a better outcome had he been able to have surgery earlier. · Healthcare visit (other): Above

MedDRA releases: 2024-11 · check-in free text available
2021-09-12
Report sent to call center — 6 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-09-14
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-14	Pfizer-BioNTech

Call center

2 call center cases

1 successful · 1 unsuccessful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-18

Systemic reaction (other): I have an ongoing medical condition with some similar symptoms. I do not think they are at all related to the Covid-19 vaccine I recently had. The symptoms haven't changed after the shot.

2021-03-19

Systemic reaction (other): These are ongoing and associated with a medical condition, not with the vaccine.

Release 9 — 3 months, dose 1

Reports this person's death

2021-06-15

Symptoms: (b)(6) died 4/21/21. During a surgical procedure. Non COVID related other than prolonging surgery due to lack of hospital availability for non COVID illnesses.

redacted (b)(6)

Release 9 — 6 months, dose 1

Reports this person's death

2021-09-12

Symptoms: Died 4.21.2021. Already provided this information. Not COVID related other than perhaps a better outcome had he been able to have surgery earlier.

Healthcare visit (other): Above

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	Unevaluable event	·	·	✓
SD	Death	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Surgery	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Unevaluable event	✓	✓	○

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