3GR-93635-09998

2 vaccinations 6 coded responses 10 check-ins 6 free-text entries 6 call cases

Sex: Male
Age at first dose: 12-15
ZIP prefix: 626 / IL
Registered: 2021-09-15

Relationship: Child or adolescent in my care
Guardian: BJ3-14899-02783
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-08-19
Dose 1 — Pfizer-BioNTech
2021-09-09
Dose 2 — Pfizer-BioNTech
Co-administered: yes
2021-09-15
Registered in v-safe
2021-09-15
Survey response — days 1–6 daily, dose 2, dependent
MedDRA: Hospitalisation, Myocarditis — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Systemic reaction (other): Hospitalized with myocarditis · Healthcare visit (other): Myocarditis after vaccinated

MedDRA releases: 2024-11 · check-in free text available
2021-09-15
Report sent to call center — days 1–6 daily, dose 2, dependent
Be unable to work or attend school · Be unable to do their normal daily activities · Get care from a doctor or other healthcare p

1 call case(s)
2021-09-16
Survey response — day 7, dose 2, dependent
MedDRA: Hospitalisation, Loss of personal independence in daily activities, Myocarditis — Feeling: Fair · Site: Pain · Headache · Be unable to work or attend school, Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Im not sure how to report any of this. (b)(6) was hospitalized from 9/12-9/15 due to myocarditis caused from the 2nd vaccine on 9/9/21. He cant attend school. He is on strict rest until 12/15/21. No school. We have multiple appointments.

MedDRA releases: 2024-11 · check-in free text available
2021-09-16
Report sent to call center — day 7, dose 2, dependent
Be unable to work or attend school · Be unable to do their normal daily activities · Get care from a doctor or other healthcare p

1 call case(s)
2021-09-17
Call 1 — Left Voicemail
2021-09-23
Survey response — day 14, dose 2, dependent
MedDRA: Chest pain — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Intermittent chest pain

MedDRA releases: 2024-11 · check-in free text available
2021-09-23
Report sent to call center — day 14, dose 2, dependent
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-09-27
Call successful
Completed over the phone
2021-09-27
Call successful
Completed over the phone
2021-09-27
Call successful
Completed over the phone
2021-09-30
Health check-in — day 21, dose 2, dependent
Feeling: Fair

Adult check-in
2021-10-09
Health check-in — day 28, dose 2, dependent
Feeling: Fair

Adult check-in
2021-10-14
Health check-in — day 35, dose 2, dependent
Feeling: Fair

Adult check-in
2021-10-21
Health check-in — day 42, dose 2, dependent
Feeling: Fair

Adult check-in
2021-12-09
Survey response — 3 months, dose 2, dependent
MedDRA: Fatigue, Mitral valve incompetence, Myopericarditis — Feeling: Fair · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Myopericarditis caused from the COVID vaccine/ Chronic exhaustion/ leaking mitral valve

MedDRA releases: 2024-11 · check-in free text available
2021-12-09
Report sent to call center — 3 months, dose 2, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-10
Call successful
Participant prefers to complete VAERS report online
2022-03-10
Survey response — 6 months, dose 2, dependent
MedDRA: Postural orthostatic tachycardia syndrome — Feeling: Fair · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Diagnosed with Postural Orthostatic Tachycardia Syndrome on 2/17/2022

MedDRA releases: 2024-11 · check-in free text available
2022-03-10
Report sent to call center — 6 months, dose 2, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-11
Call successful
Reported to VAERS during previous contact from GDIT
2022-09-09
Survey response — 12 months, dose 2, dependent
MedDRA: Heart rate increased, Heart valve incompetence, Hypotension — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Continued mitral valve regurgitation. Echo done 8/22/22. Low blood pressure. Continued high heart rate when sitting, standing, walking.

MedDRA releases: 2024-11 · check-in free text available
2022-09-09
Report sent to call center — 12 months, dose 2, dependent
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-09-12
Call successful
Reported to VAERS during previous contact from GDIT

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-08-19	Pfizer-BioNTech	No
2	2021-09-09	Pfizer-BioNTech	Yes

Call center

6 call center cases

6 successful

VAERS report filed, before or during a call: 5

See the call center timeline

Free text

Release 9 — days 1–6 daily, dose 2, dependent

2021-09-15

Systemic reaction (other): Hospitalized with myocarditis

Healthcare visit (other): Myocarditis after vaccinated

Release 9 — day 7, dose 2, dependent

2021-09-16

Healthcare visit (other): Im not sure how to report any of this. (b)(6) was hospitalized from 9/12-9/15 due to myocarditis caused from the 2nd vaccine on 9/9/21. He cant attend school. He is on strict rest until 12/15/21. No school. We have multiple appointments.

redacted (b)(6)

Release 9 — day 14, dose 2, dependent

2021-09-23

Symptoms: Intermittent chest pain

Release 10 — 3 months, dose 2, dependent

2021-12-09

Symptoms: Myopericarditis caused from the COVID vaccine/ Chronic exhaustion/ leaking mitral valve

Release 11 — 6 months, dose 2, dependent

2022-03-10

Symptoms: Diagnosed with Postural Orthostatic Tachycardia Syndrome on 2/17/2022

Release 12 — 12 months, dose 2, dependent

2022-09-09

Symptoms: Continued mitral valve regurgitation. Echo done 8/22/22. Low blood pressure. Continued high heart rate when sitting, standing, walking.

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	Hospitalisation	·	·	✓
HCVO	Loss of personal independence in daily activities	·	·	✓
HCVO	Myocarditis	·	·	✓
SD	Chest pain	·	·	✓
SD	Fatigue	·	·	✓
SD	Heart rate increased	·	·	✓
SD	Heart valve incompetence	·	·	✓
SD	Hypotension	·	·	✓
SD	Mitral valve incompetence	·	·	✓
SD	Myopericarditis	·	·	✓
SD	Postural orthostatic tachycardia syndrome	·	·	✓
SRO	Hospitalisation	·	·	✓
SRO	Myocarditis	·	·	✓

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