4BB-27581-44742

2 vaccinations 7 coded responses 7 check-ins 7 free-text entries 3 call cases

Sex: Male
Age at first dose: 16-20
ZIP prefix: 945 / CA
Registered: 2021-05-14

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-24
Dose 1 — Pfizer-BioNTech
2021-05-14
Registered in v-safe
2021-05-14
Survey response — day 14, dose 1
MedDRA: Pre-existing disease — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: (b)(6) is severely Autistic, disabled and medically fragile non-verbal, Mom is filling out this form

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Dose 2 — Pfizer-BioNTech
2021-05-22
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain upper, Aggression, Office visit, Pre-existing disease — Feeling: Poor · Site: Pain · Fever · Chills, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): This is (b)(6) Mom (b)(6), (b)(6) is non-verbal & was holding his stomach & showing pain on his iPad language program. He was overly aggressive and combative · Healthcare visit (other): Developmental pediatrics

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-22
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-23
Survey response — days 1–6 daily, dose 2
MedDRA: Abnormal behaviour, Illiteracy — Feeling: Poor · Site: Pain · Fever · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Non verbal, attacking more than normal

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-24
Survey response — days 1–6 daily, dose 2
MedDRA: Aggression, Peripheral coldness, Skin warm — Feeling: Fair · Site: Pain · Fever · Chills · Be unable to work, Be unable to do your normal daily activities

Free text: (b)(6) hands & feet were freezing cold on and off, while his forehead was burning hot. He was overly aggressive this morning but is taking a nap now. (b)(6) is non-verbal. Thank You for the vaccines. He nearly died from H1N1 virus a couple of years ago. God Bless

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-26
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good

Free text: I am just guessing since (b)(6) is non-verbal, he didnt fight too much today, and wasnt very aggressive. Thank You for keeping him safe

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-03
Survey response — day 14, dose 2
MedDRA: Aggression, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Bertrand is non/verbal and has become overly aggressive, since his 2nd dose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-03
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-03
Survey response — day 42, dose 2
MedDRA: Aggression, Chapped lips, Pre-existing disease, Pyrexia — 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 professional · Outpatient clinic or urgent care clinic visit

Free text: Bertrand who is non verbal has become more aggressive and seems to have a fever and seriously chapped- cracked lips always

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-03
Report sent to call center — day 42, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-07
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-24	Pfizer-BioNTech
2	2021-05-20	Pfizer-BioNTech

Call center

3 call center cases

3 unsuccessful

See the call center timeline

Free text

Release 8 — day 14, dose 1

2021-05-14

Symptoms: (b)(6) is severely Autistic, disabled and medically fragile non-verbal, Mom is filling out this form

redacted (b)(6)

Release 8 — days 1–6 daily, dose 2

2021-05-22

Systemic reaction (other): This is (b)(6) Mom (b)(6), (b)(6) is non-verbal & was holding his stomach & showing pain on his iPad language program. He was overly aggressive and combative

Healthcare visit (other): Developmental pediatrics

redacted (b)(6)

2021-05-23

Systemic reaction (other): Non verbal, attacking more than normal

2021-05-24

Systemic reaction (other): (b)(6) hands & feet were freezing cold on and off, while his forehead was burning hot. He was overly aggressive this morning but is taking a nap now. (b)(6) is non-verbal. Thank You for the vaccines. He nearly died from H1N1 virus a couple of years ago. God Bless

redacted (b)(6)

2021-05-26

Systemic reaction (other): I am just guessing since (b)(6) is non-verbal, he didnt fight too much today, and wasnt very aggressive. Thank You for keeping him safe

redacted (b)(6)

Release 8 — day 14, dose 2

2021-06-03

Symptoms: Bertrand is non/verbal and has become overly aggressive, since his 2nd dose

Release 9 — day 42, dose 2

2021-07-03

Symptoms: Bertrand who is non verbal has become more aggressive and seems to have a fever and seriously chapped- cracked lips always

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	✓	✓	✓
SD	Aggression	✓	✓	✓
SD	Chapped lips	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SRO	Abdominal pain upper	✓	✓	✓
SRO	Abnormal behaviour	✓	✓	✓
SRO	Aggression	✓	✓	✓
SRO	Illiteracy	✓	✓	✓
SRO	Peripheral coldness	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Skin warm	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

✓ active code · ○ coded but marked inactive · blank = not in that release