3V3-81016-24083
5 vaccinations
20 coded responses
54 check-ins
20 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 31-35
- ZIP prefix
- 727 / AR
- Registered
- 2021-03-10
- 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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2021-03-10
Registered in v-safe
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2021-03-10
Survey response — days 1–6 daily, dose 1MedDRA: Condition aggravated, Epilepsy, Pre-existing disease — Feeling: Good · Site: Pain, RednessFree text: Sam has cerebral palsy and epilepsy. He is nonverbal so difficult to tell if he has some of these symptoms. Received first shot 3/05/21. No symptoms. Seizure on Sunday, 3/07/21, evening. Most likely unrelated to vaccine as he has uncontrolled seizures.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-11
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2021-03-12
Survey response — day 7, dose 1MedDRA: Nausea, Pre-existing disease, Vomiting — Feeling: Poor · Nausea, VomitingFree text: Sam has a history of nausea/vomiting. He has cerebral palsy/epilepsy and feeding tube. He has had several episodes of nausea/vomiting today. He is also nonverbal. Not sure if this is related to vaccine.MedDRA 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
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2021-03-26
Survey response — day 0, dose 2MedDRA: Pre-existing disease — Feeling: Good · Muscle or body achesFree text: (b)(6) is not experiencing any symptoms yet but your system will not allow notes without checking a box. (b)(6) has cerebral palsy/epilepsy. He is non verbal, non ambulatory and has feeding tube. Will continue to monitor him for any symptoms.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-27
Survey response — days 1–6 daily, dose 2MedDRA: Seizure — Feeling: GoodFree text: Sam had big seizure last night 3/26/21. Not sure if related to vaccine given yesterday.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-28
Survey response — days 1–6 daily, dose 2MedDRA: Epilepsy, Nausea, Pre-existing disease, Vomiting — Feeling: Poor · Nausea, Vomiting · Be unable to do your normal daily activitiesFree text: Sam has cerebral palsy/epilepsy. Sam had another seizure last night. Some mild nausea/vomiting today. Sleeping a lot today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-30
Survey response — days 1–6 daily, dose 2MedDRA: Cerebral palsy, Epilepsy, Fatigue — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Sam had extreme fatigue yesterday and today. Slept off and on all day. Missed the check in yesterday. Sam has cerebral palsy, epilepsy, nonverbal and non ambulatory. Cannot express to us how he is feeling.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-31
- 2021-04-01
- 2021-04-02
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2021-04-10
Survey response — day 14, dose 2MedDRA: Seizure — Feeling: Poor · Be unable to do your normal daily activitiesFree text: SeizureMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-16
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2021-04-23
Survey response — day 28, dose 2MedDRA: Interventional procedure, Seizure — Feeling: Good · Be unable to do your normal daily activitiesFree text: Sam had big seizure on 4/21/21 and 4/22/21 requiring intervention to stop seizures. Not sure related to vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-30
- 2021-05-07
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2021-06-25
Survey response — 3 months, dose 2MedDRA: Condition aggravated, Pre-existing disease — Feeling: FairFree text: Increase in seizure activity.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-09-24
Survey response — 6 months, dose 2MedDRA: Seizure — Feeling: FairFree text: SeizuresMedDRA releases: 2024-11 · check-in free text available
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2021-10-01
Dose 3 — Pfizer-BioNTech
- 2021-10-02
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2021-10-03
Survey response — days 1–6 daily, dose 3MedDRA: Seizure — Feeling: Good · Site: PainFree text: Seizure last night @ 1910.MedDRA releases: 2024-11 · check-in free text available
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2021-10-04
Survey response — days 1–6 daily, dose 3MedDRA: Seizure — Feeling: GoodFree text: SeizureMedDRA releases: 2024-11 · check-in free text available
- 2021-10-05
- 2021-10-06
- 2021-10-07
- 2021-10-08
- 2021-10-15
- 2021-10-24
- 2021-10-29
- 2021-11-06
- 2021-11-12
- 2021-12-31
- 2022-04-01
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2022-04-27
Dose 4 — Pfizer-BioNTech
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2022-04-29
Survey response — days 1–6 daily, dose 4MedDRA: Pre-existing disease, Seizure — Feeling: Good · Site: PainFree text: Sam had second booster on 4/27 and following day on 4/28 had seizure. Sam has cerebral palsy/epilepsy/asthma and is medically fragile. Doctor recommended second booster for him and all family members living in home.MedDRA releases: 2024-11 · check-in free text available
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2022-04-30
Survey response — days 1–6 daily, dose 4MedDRA: Irritability, Respiratory tract congestion — Feeling: FairFree text: (b)(6)is nonverbal so he cannot tell me but he is congested and overall cranky today.MedDRA releases: 2024-11 · check-in free text available
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2022-05-01
Survey response — days 1–6 daily, dose 4MedDRA: Nasal congestion, Respiratory tract congestion — Feeling: Fair · Fatigue or tirednessFree text: Chest congestion, nasal congestionMedDRA releases: 2024-11 · check-in free text available
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2022-05-02
Survey response — days 1–6 daily, dose 4MedDRA: Nasal congestion, Respiratory tract congestion — Feeling: GoodFree text: Chest/nasal congestionMedDRA releases: 2024-11 · check-in free text available
- 2022-05-03
- 2022-05-04
- 2022-05-11
- 2022-05-20
- 2022-05-25
- 2022-06-01
- 2022-06-08
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2022-07-27
Survey response — 3 months, dose 4MedDRA: Pre-existing disease, Respiratory tract congestion, Seizure — Feeling: FairFree text: Increase in seizures. Increase in chest congestion.MedDRA releases: 2024-11 · check-in free text available
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2022-10-21
Dose 5 — Pfizer-BioNTech
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2022-10-25
Survey response — days 1–6 daily, dose 5MedDRA: Respiratory tract congestion, Seizure — Feeling: Poor · Fatigue or tirednessFree text: Sam had seizure 10/21/22 evening of day he received vaccine. Increased chest congestion. No fever.MedDRA releases: 2024-11 · check-in free text available
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2022-10-26
Survey response — days 1–6 daily, dose 5MedDRA: Irritability, Pneumonia, Respiratory tract congestion, Self-medication — Feeling: Poor · Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Systemic reaction (other): Sam has been very cranky/congested since receive COVID booster on 10/21/22. He is nonverbal do cannot communicate to me how he is feeling. Using Ibuprofen to calm him. No temp. · Healthcare visit (other): Doctor prescribing another round of antibiotics for Sam as he just had pneumonia.MedDRA releases: 2024-11 · check-in free text available
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2022-10-26
Report sent to call center — days 1–6 daily, dose 5Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-10-27
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2022-10-28
Health check-in — day 7, dose 5Feeling: Fair · Muscle or body aches, Fatigue or tirednessAdult check-in
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2022-10-28
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-11-06
- 2022-11-11
- 2022-11-18
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2022-11-25
Survey response — day 35, dose 5MedDRA: Respiratory tract congestion, Seizure — Feeling: FairFree text: Seizures Chest congestionMedDRA releases: 2024-11 · check-in free text available
- 2022-12-02
- 2023-01-20
- 2023-04-21
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-05 | Pfizer-BioNTech | |
| 2 | 2021-03-26 | Pfizer-BioNTech | |
| 3 | 2021-10-01 | Pfizer-BioNTech | No |
| 4 | 2022-04-27 | Pfizer-BioNTech | No |
| 5 | 2022-10-21 | Pfizer-BioNTech | No |
Call center
1 call center case
1 successful
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Sam has cerebral palsy and epilepsy. He is nonverbal so difficult to tell if he has some of these symptoms. Received first shot 3/05/21. No symptoms. Seizure on Sunday, 3/07/21, evening. Most likely unrelated to vaccine as he has uncontrolled seizures.
Release 5 — day 7, dose 1
Systemic reaction (other): Sam has a history of nausea/vomiting. He has cerebral palsy/epilepsy and feeding tube. He has had several episodes of nausea/vomiting today. He is also nonverbal. Not sure if this is related to vaccine.
Release 6 — day 0, dose 2
Systemic reaction (other): (b)(6) is not experiencing any symptoms yet but your system will not allow notes without checking a box. (b)(6) has cerebral palsy/epilepsy. He is non verbal, non ambulatory and has feeding tube. Will continue to monitor him for any symptoms.
redacted (b)(6)
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Sam had big seizure last night 3/26/21. Not sure if related to vaccine given yesterday.
Systemic reaction (other): Sam has cerebral palsy/epilepsy. Sam had another seizure last night. Some mild nausea/vomiting today. Sleeping a lot today.
Systemic reaction (other): Sam had extreme fatigue yesterday and today. Slept off and on all day. Missed the check in yesterday. Sam has cerebral palsy, epilepsy, nonverbal and non ambulatory. Cannot express to us how he is feeling.
Release 7 — day 14, dose 2
Symptoms: Seizure
Release 7 — day 28, dose 2
Symptoms: Sam had big seizure on 4/21/21 and 4/22/21 requiring intervention to stop seizures. Not sure related to vaccine.
Release 9 — 3 months, dose 2
Symptoms: Increase in seizure activity.
Release 9 — 6 months, dose 2
Symptoms: Seizures
Release 9 — days 1–6 daily, dose 3
Systemic reaction (other): Seizure last night @ 1910.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Seizure
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Sam had second booster on 4/27 and following day on 4/28 had seizure. Sam has cerebral palsy/epilepsy/asthma and is medically fragile. Doctor recommended second booster for him and all family members living in home.
Systemic reaction (other): (b)(6)is nonverbal so he cannot tell me but he is congested and overall cranky today.
redacted (b)(6)
Systemic reaction (other): Chest congestion, nasal congestion
Systemic reaction (other): Chest/nasal congestion
Release 12 — 3 months, dose 4
Symptoms: Increase in seizures. Increase in chest congestion.
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): Sam had seizure 10/21/22 evening of day he received vaccine. Increased chest congestion. No fever.
Systemic reaction (other): Sam has been very cranky/congested since receive COVID booster on 10/21/22. He is nonverbal do cannot communicate to me how he is feeling. Using Ibuprofen to calm him. No temp.
Healthcare visit (other): Doctor prescribing another round of antibiotics for Sam as he just had pneumonia.
Release 12 — day 35, dose 5
Symptoms: Seizures Chest congestion
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 | Pneumonia | · | · | ✓ |
| SD | Condition aggravated | ✓ | ✓ | ✓ |
| SD | Interventional procedure | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Seizure | ✓ | ✓ | ✓ |
| SRO | Cerebral palsy | ✓ | ✓ | ✓ |
| SRO | Condition aggravated | ✓ | ✓ | ✓ |
| SRO | Epilepsy | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Irritability | · | · | ✓ |
| SRO | Nasal congestion | · | · | ✓ |
| SRO | Nausea | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Respiratory tract congestion | · | · | ✓ |
| SRO | Seizure | ✓ | ✓ | ✓ |
| SRO | Self-medication | · | · | ✓ |
| SRO | Vomiting | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release