4PV-99400-49907
3 vaccinations
8 coded responses
36 check-ins
4 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 05-11
- ZIP prefix
- 919 / CA
- Registered
- 2022-05-31
- Relationship
- Child or adolescent in my care
- Guardian
- DM5-15219-93168
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
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2022-05-31
Registered in v-safe
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2022-05-31
Dose 1 — Pfizer-BioNTech
- 2022-05-31
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2022-06-01
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Site: Pain · NoneAdult check-in
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2022-06-02
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Site: Pain · NoneAdult check-in
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2022-06-03
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Site: Pain · Abdominal painAdult check-in
- 2022-06-04
- 2022-06-05
- 2022-06-07
- 2022-06-14
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2022-06-21
Survey response — day 21, dose 1, dependentMedDRA: Abdominal pain upper, Pyrexia, Vomiting — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: June 18th to 19th, complaining of stomach pain. Vomited on the evening of the 19th. Developed fever, which lasted until the 20th.MedDRA releases: 2024-11 · check-in free text available
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2022-06-22
Dose 2 — Pfizer-BioNTech
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2022-06-22
Survey response — day 0, dose 2, dependentMedDRA: Angina pectoris, Heart rate increased — Feeling: Good · Site: PainFree text: Says his heart hurts. Says it's like when he's running, so probably probably a rapid heartbeat. Seems normal otherwise, normal activity level.MedDRA releases: 2024-11 · check-in free text available
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2022-06-23
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
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2022-06-24
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Good · Site: Pain · HeadacheAdult check-in
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2022-06-25
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Good · Site: Pain · NoneAdult check-in
- 2022-06-26
- 2022-06-27
- 2022-06-28
- 2022-06-29
- 2022-07-06
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2022-07-13
Survey response — day 21, dose 2, dependentMedDRA: Cough, Nasopharyngitis, Respiratory tract congestion, SARS-CoV-2 test negative — Feeling: GoodFree text: Had a cold, stuffy and cough. Tested negative for COVID.MedDRA releases: 2024-11 · check-in free text available
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2022-07-22
Survey response — day 28, dose 2, dependentMedDRA: Cough, Malaise, Nasal congestion, Nasopharyngitis — Feeling: GoodFree text: Had a cold (stuffy nose, cough). Tested negative multiple times over the course of illness.MedDRA releases: 2024-11 · check-in free text available
- 2022-07-27
- 2022-08-03
- 2022-09-21
- 2022-12-21
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2022-12-28
Dose 3 — Pfizer-BioNTech
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2022-12-30
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activitiesAdult check-in
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2022-12-31
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
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2023-01-01
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
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2023-01-02
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Good · Fatigue or tirednessAdult check-in
- 2023-01-03
- 2023-01-04
- 2023-01-12
- 2023-01-18
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2023-01-25
Survey response — day 28, dose 3, dependentMedDRA: Abdominal pain upper, Cough, Oropharyngeal pain, Pyrexia, Respiratory tract congestion — Feeling: Poor · Be unable to work or attend schoolMedDRA releases: 2024-11
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2023-02-02
Survey response — day 35, dose 3, dependentMedDRA: Cough, Fatigue, Malaise, Respiratory tract congestion — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesMedDRA releases: 2024-11
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2023-02-08
Survey response — day 42, dose 3, dependentMedDRA: Conjunctivitis — Feeling: GoodMedDRA releases: 2024-11
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2023-06-28
Survey response — 6 months, dose 3, dependentMedDRA: Office visit, Pre-existing disease, Respiratory tract congestion — Feeling: Good · Get care from a doctor or other healthcare professionalMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2022-05-31 | Pfizer-BioNTech | No |
| 2 | 2022-06-22 | Pfizer-BioNTech | No |
| 3 | 2022-12-28 | Pfizer-BioNTech | No |
Free text
Release 12 — day 21, dose 1, dependent
Symptoms: June 18th to 19th, complaining of stomach pain. Vomited on the evening of the 19th. Developed fever, which lasted until the 20th.
Release 12 — day 0, dose 2, dependent
Systemic reaction (other): Says his heart hurts. Says it's like when he's running, so probably probably a rapid heartbeat. Seems normal otherwise, normal activity level.
Release 12 — day 21, dose 2, dependent
Symptoms: Had a cold, stuffy and cough. Tested negative for COVID.
Release 12 — day 28, dose 2, dependent
Symptoms: Had a cold (stuffy nose, cough). Tested negative multiple times over the course of illness.
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 | Abdominal pain upper | · | · | ✓ |
| SD | Conjunctivitis | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Nasal congestion | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Vomiting | · | · | ✓ |
| SRO | Angina pectoris | · | · | ✓ |
| SRO | Heart rate increased | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release