4KJ-15107-93551
1 vaccination
5 coded responses
8 check-ins
5 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 565 / MN
- Registered
- 2021-02-03
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-29
Dose 1 — Pfizer-BioNTech
-
2021-02-03
Registered in v-safe
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2021-02-03
Survey response — days 1–6 daily, dose 1MedDRA: Fatigue — Feeling: Good · Site: PainFree text: Just tired the first day of shotMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-04
- 2021-02-05
-
2021-02-12
Survey response — day 14, dose 1MedDRA: Sinus congestion — Feeling: GoodFree text: Just felt some sinus congestion in amMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-19
Survey response — day 21, dose 1MedDRA: Blood pressure increased, Dermatitis contact, Hypersensitivity — Feeling: Poor · Be unable to do your normal daily activitiesFree text: I believe it is an allergy reaction contact dermatitis on neck and face. Low lighted my hair on Tuesday. Blood pressure has been elevated for two days. Highest of 176/90. Just took it and recorded 156/88MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-30
-
2021-08-01
Survey response — 6 months, dose 1MedDRA: Pneumonia — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Had bronchial pneumonia in julyMedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-08-01
Report sent to call center — 6 months, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-08-12
Call successfulDoes not wish to fill out VAERS report
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2022-01-31
Survey response — 12 months, dose 1MedDRA: Bronchitis, Influenza A virus test negative, Influenza B virus test, Malaise, SARS-CoV-2 test negative — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Got sick with bronchitis no fever on long dosage of prednisone and z pack. Tested once for covid Meg and influenza a and n negMedDRA releases: 2024-11 · check-in free text available
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2022-01-31
Report sent to call center — 12 months, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-02-02
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-29 | Pfizer-BioNTech |
Call center
2 call center cases
2 successful
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): Just tired the first day of shot
Release 4 — day 14, dose 1
Symptoms: Just felt some sinus congestion in am
Release 4 — day 21, dose 1
Symptoms: I believe it is an allergy reaction contact dermatitis on neck and face. Low lighted my hair on Tuesday. Blood pressure has been elevated for two days. Highest of 176/90. Just took it and recorded 156/88
Release 9 — 6 months, dose 1
Symptoms: Had bronchial pneumonia in july
Release 11 — 12 months, dose 1
Symptoms: Got sick with bronchitis no fever on long dosage of prednisone and z pack. Tested once for covid Meg and influenza a and n neg
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 | Blood pressure increased | ✓ | ✓ | ✓ |
| SD | Bronchitis | · | · | ✓ |
| SD | Dermatitis contact | ✓ | ✓ | ✓ |
| SD | Hypersensitivity | ✓ | ✓ | ✓ |
| SD | Influenza A virus test negative | · | · | ✓ |
| SD | Influenza B virus test | · | · | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Pneumonia | ✓ | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Sinus congestion | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release