4LU-10718-38963
3 vaccinations
5 coded responses
29 check-ins
4 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 05-11
- ZIP prefix
- 905 / CA
- Registered
- 2021-11-10
- Relationship
- Child or adolescent in my care
- Guardian
- ECV-22770-23003
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-11-09
Dose 1 — Pfizer-BioNTech
-
2021-11-10
Registered in v-safe
-
2021-11-10
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Site: Pain · NoneAdult check-in
- 2021-11-12
- 2021-11-13
- 2021-11-15
- 2021-11-19
- 2021-11-23
-
2021-11-30
Dose 2 — Pfizer-BioNTech
- 2021-11-30
-
2021-12-01
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Good · Site: Pain · None · Be unable to work or attend schoolAdult check-in
-
2021-12-04
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Good · None · Be unable to work or attend schoolAdult check-in
- 2021-12-05
- 2021-12-06
-
2021-12-07
Survey response — day 7, dose 2, dependentMedDRA: Cough — Feeling: Fair · Be unable to work or attend schoolFree text: Slight coughMedDRA releases: 2024-11 · check-in free text available
- 2021-12-14
- 2021-12-21
- 2021-12-28
- 2022-01-07
- 2022-01-12
- 2022-03-02
-
2022-05-28
Dose 3 — Pfizer-BioNTech
- 2022-05-28
-
2022-05-29
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Good · Site: Pain, Redness, Swelling · NoneAdult check-in
- 2022-05-30
- 2022-05-31
- 2022-06-06
- 2022-06-11
-
2022-06-18
Survey response — day 21, dose 3, dependentMedDRA: Abdominal pain, Chills, Decreased appetite, Fatigue, Headache, Pyrexia, Rhinorrhoea — Feeling: Good · Be unable to do your normal daily activitiesFree text: Fatigue, decreased appetite, fever, chills, runny nose, abdominal pain, headache.,MedDRA releases: 2024-11 · check-in free text available
-
2022-06-28
Survey response — day 28, dose 3, dependentMedDRA: Abdominal pain, Chills, Decreased appetite, Headache, Nightmare, Palpitations, Pyrexia, Rhinorrhoea, Screaming, Sleep terror, Tachycardia — Feeling: Good · Be unable to do your normal daily activitiesFree text: He ended up with fever, chills, abdominal pain, headache, decreased appetite, and runny nose. He also had palpitations and tachycardia to the 180s that was intermittent & caused him to scream. Now having new nightly night terrors and nightmares.MedDRA releases: 2024-11 · check-in free text available
-
2022-07-02
Survey response — day 35, dose 3, dependentMedDRA: Amnesia, Screaming, Sleep terror — Feeling: FairFree text: He is having nightly night terrors, screaming at the top of his lungs for 3-5 minutes, and in the morning he does not remember this happening.MedDRA releases: 2024-11 · check-in free text available
- 2022-11-26
-
2023-05-29
Survey response — 12 months, dose 3, dependentMedDRA: Anxiety, Obsessive-compulsive disorder — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-05-29
Call case (no matching report) — SuccessfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-05-30
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-11-09 | Pfizer-BioNTech | No |
| 2 | 2021-11-30 | Pfizer-BioNTech | No |
| 3 | 2022-05-28 | Pfizer-BioNTech | No |
Call center
1 call center case
1 successful
Free text
Release 10 — day 7, dose 2, dependent
Systemic reaction (other): Slight cough
Release 12 — day 21, dose 3, dependent
Symptoms: Fatigue, decreased appetite, fever, chills, runny nose, abdominal pain, headache.,
Release 12 — day 28, dose 3, dependent
Symptoms: He ended up with fever, chills, abdominal pain, headache, decreased appetite, and runny nose. He also had palpitations and tachycardia to the 180s that was intermittent & caused him to scream. Now having new nightly night terrors and nightmares.
Release 12 — day 35, dose 3, dependent
Symptoms: He is having nightly night terrors, screaming at the top of his lungs for 3-5 minutes, and in the morning he does not remember this happening.
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 | Abdominal pain | · | · | ✓ |
| SD | Amnesia | · | · | ✓ |
| SD | Anxiety | · | · | ✓ |
| SD | Chills | · | · | ✓ |
| SD | Decreased appetite | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Nightmare | · | · | ✓ |
| SD | Obsessive-compulsive disorder | · | · | ✓ |
| SD | Palpitations | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Screaming | · | · | ✓ |
| SD | Sleep terror | · | · | ✓ |
| SD | Tachycardia | · | · | ✓ |
| SRO | Cough | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release