4HQ-16623-87507

5 vaccinations 13 coded responses 57 check-ins 10 free-text entries 3 call cases

Sex: Male
Age at first dose: 05-11
ZIP prefix: 981 / WA
Registered: 2021-11-06

Relationship: Child or adolescent in my care
Guardian: 6F6-20631-64368
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-11-06
Registered in v-safe
2021-11-06
Dose 1 — Pfizer-BioNTech
2021-11-06
Health check-in — day 0, dose 1, dependent
Feeling: Good · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 1, dependent
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-11-10
Survey response — days 1–6 daily, dose 1, dependent
MedDRA: Oropharyngeal pain — Feeling: Good

Free text: Sore throat yesterday

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Health check-in — days 1–6 daily, dose 1, dependent
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-11-12
Health check-in — days 1–6 daily, dose 1, dependent
Feeling: Good · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-11-13
Survey response — day 7, dose 1, dependent
MedDRA: Lymphadenopathy, Pain, Self-medication — Feeling: Good · Site: Pain, Redness, Swelling

Free text: Swollen lymph nodes in left arm pit, treating pain with advil

MedDRA releases: 2024-11 · check-in free text available
2021-11-20
Health check-in — day 14, dose 1, dependent
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 21, dose 1, dependent
Feeling: Good

Adult check-in
2021-12-01
Dose 2 — Pfizer-BioNTech
2021-12-01
Health check-in — day 0, dose 2, dependent
Feeling: Good · Site: Pain · None

Adult check-in
2021-12-02
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Fair · Site: Pain, Redness · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2021-12-04
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-12-05
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2021-12-06
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · Site: Pain, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-12-07
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · Site: Pain, Itching · Fatigue or tiredness, Nausea

Adult check-in
2021-12-24
Survey response — day 21, dose 2, dependent
MedDRA: Office visit, Pain in extremity, Peripheral swelling — Feeling: Good · 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: Symptoms: Leg and foot pain on and off, swelling of left foot- doctor xrayed foot and no fracture visible, could be growth plate issue? · Healthcare visit (other): Clinic visit in person

MedDRA releases: 2024-11 · check-in free text available
2021-12-24
Report sent to call center — day 21, dose 2, dependent
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-27
Call 1 — Left Voicemail
2021-12-31
Health check-in — day 28, dose 2, dependent
Feeling: Good

Adult check-in
2022-01-05
Health check-in — day 35, dose 2, dependent
Feeling: Good

Adult check-in
2022-01-13
Survey response — day 42, dose 2, dependent
MedDRA: Pain in extremity, Throat irritation — Feeling: Fair · Be unable to work or attend school

Free text: Aching feet- persistent, today scratchy throat

MedDRA releases: 2024-11 · check-in free text available
2022-03-02
Survey response — 3 months, dose 2, dependent
MedDRA: Urine abnormality — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Discharge in urine, need to drink more water, kidney ultrasound may happen next week if symptoms do not improve

MedDRA releases: 2024-11 · check-in free text available
2022-03-02
Report sent to call center — 3 months, dose 2, dependent
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-03
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-05-21
Dose 3 — Pfizer-BioNTech
2022-05-21
Health check-in — day 0, dose 3, dependent
Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Fatigue or tiredness

Adult check-in
2022-05-22
Health check-in — days 1–6 daily, dose 3, dependent
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-23
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Respiratory tract congestion — Feeling: Fair · Site: Pain, Swelling, Itching · Fatigue or tiredness, Diarrhea · Be unable to work or attend school

Free text: Congestion overnight

MedDRA releases: 2024-11 · check-in free text available
2022-05-24
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Nasal congestion — Feeling: Fair · Site: Pain, Swelling, Itching · Fatigue or tiredness

Free text: A little nasal congestion

MedDRA releases: 2024-11 · check-in free text available
2022-05-25
Health check-in — days 1–6 daily, dose 3, dependent
Feeling: Fair · Site: Pain, Swelling, Itching · Fatigue or tiredness

Adult check-in
2022-05-27
Health check-in — days 1–6 daily, dose 3, dependent
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2022-05-28
Health check-in — day 7, dose 3, dependent
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2022-06-04
Health check-in — day 14, dose 3, dependent
Feeling: Good

Adult check-in
2022-06-11
Survey response — day 21, dose 3, dependent
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Exhaustion- just exposed with many positive contacts and will be getting pcr tomorrow. Rapid this morning was negative

MedDRA releases: 2024-11 · check-in free text available
2022-06-18
Health check-in — day 28, dose 3, dependent
Feeling: Good

Adult check-in
2022-06-25
Health check-in — day 35, dose 3, dependent
Feeling: Good

Adult check-in
2022-07-02
Health check-in — day 42, dose 3, dependent
Feeling: Good

Adult check-in
2022-09-22
Dose 4 — Pfizer-BioNTech
Co-administered: Flu
2022-09-22
Health check-in — day 0, dose 4, dependent
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2022-09-23
Health check-in — days 1–6 daily, dose 4, dependent
Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school

Adult check-in
2022-09-25
Survey response — days 1–6 daily, dose 4, dependent
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Swollen arm pit lymph nodes

MedDRA releases: 2024-11 · check-in free text available
2022-09-26
Survey response — days 1–6 daily, dose 4, dependent
MedDRA: Burning sensation, Lymphadenopathy — Feeling: Good · Site: Pain, Swelling · Headache, Joint pains, Fatigue or tiredness

Free text: Burning sensation in arm pit with swollen lymph nodes

MedDRA releases: 2024-11 · check-in free text available
2022-09-28
Health check-in — days 1–6 daily, dose 4, dependent
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2022-09-29
Health check-in — day 7, dose 4, dependent
Feeling: Fair · Site: Pain · Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2022-10-06
Health check-in — day 14, dose 4, dependent
Feeling: Good

Adult check-in
2022-10-15
Health check-in — day 21, dose 4, dependent
Feeling: Good

Adult check-in
2022-10-20
Health check-in — day 28, dose 4, dependent
Feeling: Good

Adult check-in
2022-10-29
Health check-in — day 35, dose 4, dependent
Feeling: Good

Adult check-in
2022-11-03
Health check-in — day 42, dose 4, dependent
Feeling: Good

Adult check-in
2022-12-24
Health check-in — 3 months, dose 4, dependent
Feeling: Good

Adult check-in
2023-03-23
Health check-in — 6 months, dose 4, dependent
Feeling: Good

Adult check-in
2023-04-21
Dose 5 — Moderna
2023-04-21
Health check-in — day 0, dose 5, dependent
Feeling: Good · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2023-04-22
Health check-in — days 1–6 daily, dose 5, dependent
Feeling: Good · Site: Pain, Redness · Fever · Muscle or body aches, Fatigue or tiredness

Adult check-in
2023-04-23
Health check-in — days 1–6 daily, dose 5, dependent
Feeling: Good · Site: Pain, Redness, Swelling · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2023-04-24
Survey response — days 1–6 daily, dose 5, dependent
MedDRA: Oropharyngeal pain — Feeling: Good · Site: Pain, Redness, Swelling · Fever · Muscle or body aches, Fatigue or tiredness

MedDRA releases: 2024-11
2023-04-25
Health check-in — days 1–6 daily, dose 5, dependent
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2023-04-26
Health check-in — days 1–6 daily, dose 5, dependent
Feeling: Good · None

Adult check-in
2023-04-27
Health check-in — days 1–6 daily, dose 5, dependent
Feeling: Good · None

Adult check-in
2023-04-28
Survey response — day 7, dose 5, dependent
MedDRA: Adverse reaction — Feeling: Good

MedDRA releases: 2024-11
2023-05-05
Health check-in — day 14, dose 5, dependent
Feeling: Good

Adult check-in
2023-05-17
Survey response — day 21, dose 5, dependent
MedDRA: Oropharyngeal pain, Pyrexia, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-05-17
Report sent to call center — day 21, dose 5, dependent
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-05-18
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-05-19
Health check-in — day 28, dose 5, dependent
Feeling: Good

Adult check-in
2023-05-26
Health check-in — day 35, dose 5, dependent
Feeling: Good

Adult check-in
2023-06-03
Health check-in — day 42, dose 5, dependent
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-11-06	Pfizer-BioNTech	No
2	2021-12-01	Pfizer-BioNTech	No
3	2022-05-21	Pfizer-BioNTech	No
4	2022-09-22	Pfizer-BioNTech	Flu
5	2023-04-21	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 10 — days 1–6 daily, dose 1, dependent

2021-11-10

Systemic reaction (other): Sore throat yesterday

Release 10 — day 7, dose 1, dependent

2021-11-13

Systemic reaction (other): Swollen lymph nodes in left arm pit, treating pain with advil

Release 10 — day 21, dose 2, dependent

2021-12-24

Symptoms: Leg and foot pain on and off, swelling of left foot- doctor xrayed foot and no fracture visible, could be growth plate issue?

Healthcare visit (other): Clinic visit in person

Release 10 — day 42, dose 2, dependent

2022-01-13

Symptoms: Aching feet- persistent, today scratchy throat

Release 11 — 3 months, dose 2, dependent

2022-03-02

Symptoms: Discharge in urine, need to drink more water, kidney ultrasound may happen next week if symptoms do not improve

Release 11 — days 1–6 daily, dose 3, dependent

2022-05-23

Systemic reaction (other): Congestion overnight

2022-05-24

Systemic reaction (other): A little nasal congestion

Release 12 — day 21, dose 3, dependent

2022-06-11

Symptoms: Exhaustion- just exposed with many positive contacts and will be getting pcr tomorrow. Rapid this morning was negative

Release 12 — days 1–6 daily, dose 4, dependent

2022-09-25

Systemic reaction (other): Swollen arm pit lymph nodes

2022-09-26

Systemic reaction (other): Burning sensation in arm pit with swollen lymph nodes

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	Fatigue	·	·	✓
SD	Office visit	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Peripheral swelling	·	·	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Throat irritation	·	·	✓
SD	Urine abnormality	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Burning sensation	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Nasal congestion	·	·	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Pain	·	·	✓
SRO	Respiratory tract congestion	·	·	✓
SRO	Self-medication	·	·	✓

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