3GX-16201-03671
3 vaccinations
6 coded responses
12 check-ins
6 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 05-11
- ZIP prefix
- 220 / VA
- Registered
- 2022-06-24
- Relationship
- Child or adolescent in my care
- Guardian
- W7R-38624-63075
- Race
- Multiracial
- Ethnicity
- N/A
Timeline
-
2021-11-21
Dose 1 — Pfizer-BioNTech
-
2021-12-19
Dose 2 — Pfizer-BioNTech
-
2022-06-24
Registered in v-safe
-
2022-06-29
Dose 3 — Pfizer-BioNTech
-
2022-06-29
Survey response — day 0, dose 3, dependentMedDRA: Eye swelling, Malaise, Office visit, Pyrexia, Urticaria, Viral infection — Feeling: Fair · Site: Pain · Fever · Muscle or body achesFree text: He's had hives at night for a month now. Today, vaccine given at 10am. At 9pm, his left eye is swollen. Not sure from what. Working with allergist about hives. They think it was from when he was sick in April with high fever; unknown virusMedDRA releases: 2024-11 · check-in free text available
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2022-06-30
Survey response — days 1–6 daily, dose 3, dependentMedDRA: Eye swelling — Feeling: Good · Site: PainFree text: Eye is still a little swollen but it doesn't hurtMedDRA releases: 2024-11 · check-in free text available
-
2022-07-01
Survey response — days 1–6 daily, dose 3, dependentMedDRA: Eye swelling — Feeling: Good · Site: PainFree text: The swelling on his eye is gone now.MedDRA releases: 2024-11 · check-in free text available
- 2022-07-03
- 2022-07-04
- 2022-07-05
- 2022-07-06
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2022-07-13
Survey response — day 14, dose 3, dependentMedDRA: Fatigue, Pyrexia, SARS-CoV-2 test negative, Urticaria — 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 · Telehealth, virtual health, or email health consultationFree text: Symptoms: Harry got a fever on Monday, 7/11, highest was 102.9. On Tuesday, still high fever and hives on eye. Today, 7/12, fever in the 101's and high 100's. He was very tired on Monday and mostly Tuesday, had more energy today. · Healthcare visit (other): We tested at home for Covid on 7/11, it was negative.MedDRA releases: 2024-11 · check-in free text available
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2022-07-13
Report sent to call center — day 14, dose 3, dependentBe unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · 1 call case(s)
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2022-07-14
Call successfulParticipant prefers to complete VAERS report online
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2022-07-20
Survey response — day 21, dose 3, dependentMedDRA: Cough, Self-medication — Feeling: Good · Be unable to work or attend schoolFree text: Still has a lingering cough. He missed all 5 days of day camp last week (7/11-7/15), however, he is at camp this week. He is wearing a face mask to keep his cough to himself. He's taking cough syrup, vapor rub on chest, cough drops to help.MedDRA releases: 2024-11 · check-in free text available
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2022-07-29
Survey response — day 28, dose 3, dependentMedDRA: Cough, Loss of personal independence in daily activities, Nasal congestion, Office visit, Rhinorrhoea, Sinusitis — 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 professionalFree text: Symptoms: (b)(6) was feeling better, went to day camp last week, got an awful cough and runny/stuffy nose. Went to dr 7/14, got prescription for sinus infection. Missed 3 days of camp this week. · Healthcare visit (other): Went to pediatricianMedDRA releases: 2024-11 · check-in free text available
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2022-07-29
Report sent to call center — day 28, dose 3, dependentBe unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
- 2022-08-01
- 2022-08-01
- 2022-08-12
- 2022-09-28
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-11-21 | Pfizer-BioNTech | No |
| 2 | 2021-12-19 | Pfizer-BioNTech | No |
| 3 | 2022-06-29 | Pfizer-BioNTech | No |
Call center
2 call center cases
1 successful · 1 unsuccessful
Free text
Release 12 — day 0, dose 3, dependent
Systemic reaction (other): He's had hives at night for a month now. Today, vaccine given at 10am. At 9pm, his left eye is swollen. Not sure from what. Working with allergist about hives. They think it was from when he was sick in April with high fever; unknown virus
Release 12 — days 1–6 daily, dose 3, dependent
Systemic reaction (other): Eye is still a little swollen but it doesn't hurt
Systemic reaction (other): The swelling on his eye is gone now.
Release 12 — day 14, dose 3, dependent
Symptoms: Harry got a fever on Monday, 7/11, highest was 102.9. On Tuesday, still high fever and hives on eye. Today, 7/12, fever in the 101's and high 100's. He was very tired on Monday and mostly Tuesday, had more energy today.
Healthcare visit (other): We tested at home for Covid on 7/11, it was negative.
Release 12 — day 21, dose 3, dependent
Symptoms: Still has a lingering cough. He missed all 5 days of day camp last week (7/11-7/15), however, he is at camp this week. He is wearing a face mask to keep his cough to himself. He's taking cough syrup, vapor rub on chest, cough drops to help.
Release 12 — day 28, dose 3, dependent
Symptoms: (b)(6) was feeling better, went to day camp last week, got an awful cough and runny/stuffy nose. Went to dr 7/14, got prescription for sinus infection. Missed 3 days of camp this week.
Healthcare visit (other): Went to pediatrician
redacted (b)(6)
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 | Office visit | · | · | ✓ |
| HCVO | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Loss of personal independence in daily activities | · | · | ✓ |
| SD | Nasal congestion | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Self-medication | · | · | ✓ |
| SD | Sinusitis | · | · | ✓ |
| SD | Urticaria | · | · | ✓ |
| SRO | Eye swelling | · | · | ✓ |
| SRO | Malaise | · | · | ✓ |
| SRO | Office visit | · | · | ✓ |
| SRO | Pyrexia | · | · | ✓ |
| SRO | Urticaria | · | · | ✓ |
| SRO | Viral infection | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release