3YS-29217-69317
2 vaccinations
3 coded responses
22 check-ins
3 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 303 / GA
- Registered
- 2021-01-12
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-12
Registered in v-safe
-
2021-01-12
Dose 1 — Pfizer-BioNTech
- 2021-01-12
- 2021-01-13
- 2021-01-14
- 2021-01-15
- 2021-01-16
- 2021-01-17
- 2021-01-18
- 2021-01-19
- 2021-01-26
-
2021-02-03
Dose 2 — Pfizer-BioNTech
- 2021-02-04
-
2021-02-05
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-10
- 2021-02-17
- 2021-02-26
- 2021-03-04
-
2021-03-10
Survey response — day 35, dose 2MedDRA: Nasopharyngitis — Feeling: Fair · Be unable to workFree text: Feel like I have a bad cold. No fever. All in my head, not in my chest.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-20
-
2021-05-07
Survey response — 3 months, dose 2MedDRA: CSF shunt operation, Cerebral haemorrhage, Hospitalisation — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · HospitalizationFree text: (b)(6) is in the hospital being treated for a brain bleed. Caused we think by a shunt being inserted in his head to drain excess fluid caused by normal hydrocephalus.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-07
Report sent to call center — 3 months, dose 2Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2022-01-07
-
2022-02-03
Survey response — 12 months, dose 2MedDRA: Cerebral haemorrhage, Death, Hospitalisation, Intensive care, Procedural complication, Sepsis, Surgery — Feeling: Poor · Get care from a doctor or other healthcare professional · HospitalizationFree text: Symptoms: My husband had a brain bleed from complications from surgery and died on June 4th, 2021. None of this was related to the Covid vaccine or Covid. He never contracted Covid. · Healthcare visit (other): Was in ICU for almost 30 days and died 7 days later after being transferred to a long term acute care hospital. Developed sepsis ther and died in an ICU IN ANOTHER HOSPITALMedDRA releases: 2024-11 · check-in free text available
-
2022-02-03
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professionalHospitalization · 1 call case(s)
- 2022-02-04
-
2022-02-07
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-12 | Pfizer-BioNTech | |
| 2 | 2021-02-03 | Pfizer-BioNTech |
Call center
2 call center cases
2 successful
1 wait over 3 months for a first call
Free text
Release 5 — day 35, dose 2
Symptoms: Feel like I have a bad cold. No fever. All in my head, not in my chest.
Release 8 — 3 months, dose 2
Symptoms: (b)(6) is in the hospital being treated for a brain bleed. Caused we think by a shunt being inserted in his head to drain excess fluid caused by normal hydrocephalus.
redacted (b)(6)
Release 11 — 12 months, dose 2
Reports this person's death
Symptoms: My husband had a brain bleed from complications from surgery and died on June 4th, 2021. None of this was related to the Covid vaccine or Covid. He never contracted Covid.
Healthcare visit (other): Was in ICU for almost 30 days and died 7 days later after being transferred to a long term acute care hospital. Developed sepsis ther and died in an ICU IN ANOTHER HOSPITAL
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 | Death | · | · | ✓ |
| HCVO | Hospitalisation | · | · | ✓ |
| HCVO | Intensive care | · | · | ✓ |
| HCVO | Sepsis | · | · | ✓ |
| SD | Cerebral haemorrhage | ✓ | ✓ | ✓ |
| SD | CSF shunt operation | ✓ | ✓ | ✓ |
| SD | Death | · | · | ✓ |
| SD | Hospitalisation | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | ✓ | ✓ | ✓ |
| SD | Procedural complication | · | · | ✓ |
| SD | Surgery | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release