3KD-11121-57988
2 vaccinations
5 coded responses
21 check-ins
5 free-text entries
4 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 207 / MD
- Registered
- 2021-03-29
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-28
Dose 1 — Pfizer-BioNTech
-
2021-03-29
Registered in v-safe
- 2021-03-29
- 2021-03-30
- 2021-03-31
- 2021-04-01
-
2021-04-02
Health check-in — days 1–6 daily, dose 1Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
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2021-04-03
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: Rash on upper right chest area above breast. Small area on left wrist and have itching at both areas. Taking Benadryl and using Cortizone-10MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-04
Survey response — day 7, dose 1MedDRA: Medical counselling, Pruritus, Rash, Self-medication, Urticaria — Feeling: Good · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Systemic reaction (other): Rash/hives got worse & itching not controlled well with benadryl & cortizone cream. · Healthcare visit (other): Dr. (b)(6) at Kaiser (b)(6) telephone visit and submitted picture of area on chest. RX called into pharmacy and sons picked up from (b)(6) Kaiser last night. Never ran temp or difficulty breathing.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-04
Report sent to call center — day 7, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-11
-
2021-04-18
Dose 2 — Pfizer-BioNTech
- 2021-04-18
- 2021-04-19
- 2021-04-23
- 2021-04-24
- 2021-04-25
- 2021-05-02
-
2021-05-09
Survey response — day 21, dose 2MedDRA: Pruritus, Urticaria — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Hives and itchy skinMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-09
Report sent to call center — day 21, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-05-16
-
2021-05-23
Survey response — day 35, dose 2MedDRA: Rash — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: RashMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-23
Report sent to call center — day 35, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-05-30
- 2021-06-15
-
2021-06-15
Callback requested for6:00PM ET
-
2021-06-15
Call successfulCompleted over the phone
- 2021-07-20
- 2021-10-18
-
2022-04-18
Survey response — 12 months, dose 2MedDRA: Benign renal neoplasm, Hepatic neoplasm, Magnetic resonance imaging head abnormal, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: MRI shows benign tumor kidney area and now Oncologist ordered new scan for small spot on liver. · Healthcare visit (other): MRIs & CT lung scanMedDRA releases: 2024-11 · check-in free text available
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2022-04-18
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-04-19
- 2022-04-29
-
2022-04-29
Callback requested forAnytime
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-28 | Pfizer-BioNTech | |
| 2 | 2021-04-18 | Pfizer-BioNTech |
Call center
4 call center cases
3 successful · 1 unsuccessful
VAERS report filed, before or during a call: 3
Free text
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): Rash on upper right chest area above breast. Small area on left wrist and have itching at both areas. Taking Benadryl and using Cortizone-10
Release 6 — day 7, dose 1
Systemic reaction (other): Rash/hives got worse & itching not controlled well with benadryl & cortizone cream.
Healthcare visit (other): Dr. (b)(6) at Kaiser (b)(6) telephone visit and submitted picture of area on chest. RX called into pharmacy and sons picked up from (b)(6) Kaiser last night. Never ran temp or difficulty breathing.
redacted (b)(6)
Release 8 — day 21, dose 2
Symptoms: Hives and itchy skin
Release 8 — day 35, dose 2
Symptoms: Rash
Release 11 — 12 months, dose 2
Symptoms: MRI shows benign tumor kidney area and now Oncologist ordered new scan for small spot on liver.
Healthcare visit (other): MRIs & CT lung scan
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 | Medical counselling | ✓ | ✓ | ✓ |
| HCVO | Unevaluable event | · | · | ✓ |
| SD | Benign renal neoplasm | · | · | ✓ |
| SD | Hepatic neoplasm | · | · | ✓ |
| SD | Magnetic resonance imaging head abnormal | · | · | ✓ |
| SD | Pruritus | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SD | Urticaria | ✓ | ✓ | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
| SRO | Rash | ✓ | ✓ | ✓ |
| SRO | Rash pruritic | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
| SRO | Urticaria | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release