4M4-11383-97272
1 vaccination
5 coded responses
12 check-ins
5 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 124 / NY
- Registered
- 2021-03-10
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-03-10
Registered in v-safe
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2021-03-10
Dose 1 — Pfizer-BioNTech
- 2021-03-10
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2021-03-11
Survey response — days 1–6 daily, dose 1MedDRA: Back pain — Feeling: Fair · Site: Pain · Muscle or body achesFree text: Lower Back PainMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-13
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Itching · Diarrhea · Be unable to do your normal daily activitiesAdult check-in
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2021-03-17
Health check-in — day 7, dose 1Feeling: Poor · Fever · Chills, Muscle or body aches, DiarrheaAdult check-in
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2021-03-24
Survey response — day 14, dose 1MedDRA: Chills, Dyspnoea, Insomnia, Office visit, Pyrexia, Sleep disorder — Feeling: Poor · Be unable to work, Be unable to do your normal daily activitiesFree text: Had occasional fevers and chills but they seem to have subsided. Still experiencing Difficulty breathing at times and difficulty sleeping because of the breathing issues.Several Doctor follow up visits and will continue to seek treatment.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-05
Survey response — day 21, dose 1MedDRA: Hospitalisation, Intensive care, Pneumonia, Stent placement — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Spent 13 days in ICU AND HAD STENT PUT IN HEART VALVE AND Pneumonia in both lungs. Looking for advice about obtaining 2nd doseage after discharge from (b)(6) Medical Center 4-4-2021.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-05
Report sent to call center — day 21, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-07
Survey response — day 28, dose 1MedDRA: Coronary arterial stent insertion, Office visit, Postoperative care — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, HospitalizationFree text: Symptoms: Recovering from having a stent placed in my heart.Trying to get advice about getting second dose so soon after heart surgery. Please contact me. · Healthcare visit (other): Doctor VisitMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-07
Report sent to call center — day 28, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-14
Survey response — day 35, dose 1MedDRA: Emergency care — 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: In the hospital. Still waiting for your phone call.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-14
Report sent to call center — day 35, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-21
- 2021-06-09
- 2021-09-08
- 2021-12-21
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2021-12-21
Call successfulParticipant prefers to complete VAERS report online
- 2022-03-14
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-10 | Pfizer-BioNTech |
Call center
3 call center cases
3 successful
1 wait over 3 months for a first call
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Lower Back Pain
Release 6 — day 14, dose 1
Symptoms: Had occasional fevers and chills but they seem to have subsided. Still experiencing Difficulty breathing at times and difficulty sleeping because of the breathing issues.Several Doctor follow up visits and will continue to seek treatment.
Release 6 — day 21, dose 1
Symptoms: Spent 13 days in ICU AND HAD STENT PUT IN HEART VALVE AND Pneumonia in both lungs. Looking for advice about obtaining 2nd doseage after discharge from (b)(6) Medical Center 4-4-2021.
redacted (b)(6)
Release 7 — day 28, dose 1
Symptoms: Recovering from having a stent placed in my heart.Trying to get advice about getting second dose so soon after heart surgery. Please contact me.
Healthcare visit (other): Doctor Visit
Release 7 — day 35, dose 1
Symptoms: In the hospital. Still waiting for your phone call.
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 | Chills | ✓ | ✓ | ✓ |
| SD | Coronary arterial stent insertion | ✓ | · | ✓ |
| SD | Dyspnoea | ✓ | ✓ | ✓ |
| SD | Emergency care | ✓ | ✓ | ✓ |
| SD | Hospitalisation | ✓ | ✓ | ✓ |
| SD | Insomnia | ✓ | ✓ | ○ |
| SD | Intensive care | ✓ | ✓ | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pneumonia | ✓ | ✓ | ✓ |
| SD | Postoperative care | ○ | ✓ | ○ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Sleep disorder | · | · | ✓ |
| SD | Stent placement | ✓ | ✓ | ✓ |
| SRO | Back pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release