3MA-13616-01387
4 vaccinations
8 coded responses
10 check-ins
8 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 060 / CT
- Registered
- 2021-03-06
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-03-05
Dose 1 — Pfizer-BioNTech
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2021-03-06
Registered in v-safe
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2021-03-06
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-07
Survey response — days 1–6 daily, dose 1MedDRA: Decreased appetite — Feeling: Fair · Chills, Headache, Muscle or body achesFree text: Loss of appetite-however, dont think related to vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-08
Survey response — days 1–6 daily, dose 1MedDRA: Arthritis, Pre-existing disease — Feeling: GoodFree text: Symptoms I have not related to vaccine, so not checking off some I have that are related to arthritis NOT vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-09
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: GoodFree text: Not anything related to injectionMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-10
Survey response — days 1–6 daily, dose 1MedDRA: Chills — Feeling: GoodFree text: Any medical issues are related to osteoporosis and Lyme , NOT the vaccine. Only thing I noticed for short time was slight chillsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-11
Survey response — days 1–6 daily, dose 1MedDRA: Arthritis, Pre-existing disease — Feeling: FairFree text: Fair is related to arthritis, NOT vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-12
Survey response — day 7, dose 1MedDRA: Arthralgia — Feeling: GoodFree text: Only arthritic joint pain NOT related to vaccinesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-19
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2021-03-26
Dose 2 — Pfizer-BioNTech
- 2021-09-03
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2021-10-18
Dose 3 — Pfizer-BioNTech
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2022-03-28
Survey response — 12 months, dose 2MedDRA: Unevaluable event — Feeling: FairFree text: Not related to SARS-CoV-19, had all 3 Phizer, awaiting 4th if approved.MedDRA releases: 2024-11 · check-in free text available
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2022-04-14
Dose 4 — Pfizer-BioNTech
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-05 | Pfizer-BioNTech | |
| 2 | 2021-03-26 | Pfizer-BioNTech | No |
| 3 | 2021-10-18 | Pfizer-BioNTech | No |
| 4 | 2022-04-14 | Pfizer-BioNTech | No |
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): No
Systemic reaction (other): Loss of appetite-however, dont think related to vaccine
Systemic reaction (other): Symptoms I have not related to vaccine, so not checking off some I have that are related to arthritis NOT vaccine
Systemic reaction (other): Not anything related to injection
Systemic reaction (other): Any medical issues are related to osteoporosis and Lyme , NOT the vaccine. Only thing I noticed for short time was slight chills
Systemic reaction (other): Fair is related to arthritis, NOT vaccine
Release 5 — day 7, dose 1
Systemic reaction (other): Only arthritic joint pain NOT related to vaccines
Release 11 — 12 months, dose 2
Symptoms: Not related to SARS-CoV-19, had all 3 Phizer, awaiting 4th if approved.
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 |
|---|---|---|---|---|
| SD | Unevaluable event | · | · | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Arthritis | ✓ | ✓ | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Decreased appetite | ✓ | ✓ | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release