4Z5-49507-88642

3 vaccinations 11 coded responses 13 check-ins 11 free-text entries 6 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 631 / MO
Registered: 2021-08-12

Relationship: Other
Guardian: LLA-35386-85094
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-03-13
Dose 1 — Pfizer-BioNTech
2021-04-03
Dose 2 — Pfizer-BioNTech
2021-08-12
Registered in v-safe
2021-10-02
Survey response — 6 months, dose 2, dependent
MedDRA: Cerebral disorder, Condition aggravated, Office visit, Parkinson's disease, Pre-existing disease, Vomiting — Feeling: Fair · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: His Memory is worse, and his Parkinsons Walk is also. His Liver problems make his brain functions unpredictable, especially when he doesnt eat properly, and take his medications. He has been throwing them up after taking, makes it worse. · Healthcare visit (other): Doctors appointments

MedDRA releases: 2024-11 · check-in free text available
2021-10-02
Report sent to call center — 6 months, dose 2, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-04
Dose 3 — Pfizer-BioNTech
2021-10-07
Health check-in — days 1–6 daily, dose 3, dependent
Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-09
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Gait disturbance — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities

Free text: More problems walking than usual

MedDRA releases: 2024-11 · check-in free text available
2021-10-10
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Fatigue, Gait disturbance — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities

Free text: Better than yesterday, walking sometimes better sometimes not, Fatigue

MedDRA releases: 2024-11 · check-in free text available
2021-10-11
Call successful
Completed over the phone
2021-10-13
Survey response — day 7, dose 3, dependent
MedDRA: Fatigue, Gait disturbance, Irritability, Somnolence — Feeling: Fair · Be unable to do your normal daily activities

Free text: Walking problems continuing, exhausted all the time, sleeping , grouchy, listing problem solving skills

MedDRA releases: 2024-11 · check-in free text available
2021-10-24
Survey response — day 14, dose 3, dependent
MedDRA: Hypersomnia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Sleeping more caused mealtime to change. He skipped some of his Meds.

MedDRA releases: 2024-11 · check-in free text available
2021-10-25
Survey response — day 21, dose 3, dependent
MedDRA: Gait disturbance, Loss of personal independence in daily activities, Mental impairment, Mobility decreased, Physiotherapy — Feeling: Fair · Be unable to do your normal daily activities

Free text: Walking and thinking worse. Trouble dressing himself and getting in and out of bed. He started Home Physical Therapy

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Survey response — day 28, dose 3, dependent
MedDRA: Balance disorder, Decreased appetite, Malaise, Medical counselling, Physiotherapy, Tremor — Feeling: Fair · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Didn't feel well several days, didn't eat much, missed several doses of Lactulose and other medications. Had shaking and balanced problems after urinating. Now has home Health and Physical Therapy visits.

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Report sent to call center — day 28, dose 3, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-11-08
Survey response — day 35, dose 3, dependent
MedDRA: Confusional state, Dementia, Fall, Hospitalisation, Hypersomnia, Hypophagia, Urinary incontinence — Feeling: Poor · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Confusion, dementia, falling, sleeping most of the time, is now Hospitalized, loss of bladder control, not eating or drinking anything. Hospital unable to get a stool sample to test

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Report sent to call center — day 35, dose 3, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-11-10
Call 1 — Could Not Reach Participant
2021-11-15
Health check-in — day 42, dose 3, dependent
Feeling: Fair

Adult check-in
2021-11-15
Call successful
Participant prefers to complete VAERS report online
2021-11-15
Call successful
Participant prefers to complete VAERS report online
2022-01-03
Survey response — 3 months, dose 3, dependent
MedDRA: Brain fog, Communication disorder, Confusional state, Depression, Fall, Gait disturbance, Hospitalisation, Nausea, Physiotherapy, Rehabilitation therapy, Social avoidant behaviour, Tremor, Vomiting — Feeling: Poor · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: Cloudy thinking, moved to Nursing Home from Hospital for Physical Therapy, Nausea, Throwing up, unsteady on his feet and falling. Increased Confusion, Depression, Withdrawn, shaking, less communication even for things he wants · Healthcare visit (other): Hospital then Nursing Home

MedDRA releases: 2024-11 · check-in free text available
2022-01-03
Report sent to call center — 3 months, dose 3, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-01-04
Call 1 — Could Not Reach Participant
2022-01-07
Call 2 — Could Not Reach Participant
2022-04-06
Survey response — 6 months, dose 3, dependent
MedDRA: Ammonia increased, Decubitus ulcer, Hepatic failure, Hospitalisation, Rehabilitation therapy — Feeling: Fair · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Complete Liver Failure, and intermittent trips between the Hospital and nursing home for not responding, when Ammonia levels in the blood are too high. Bed sores, limited function in multiple areas

MedDRA releases: 2024-11 · check-in free text available
2022-04-06
Report sent to call center — 6 months, dose 3, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-04-11
Call 1 — Left Voicemail
2022-10-05
Survey response — 12 months, dose 3, dependent
MedDRA: Death, Hospitalisation — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: He Died · Healthcare visit (other): Nursing Home and Hospital

MedDRA releases: 2024-11 · check-in free text available
2022-10-05
Report sent to call center — 12 months, dose 3, 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

Hospitalization · 1 call case(s)
2022-10-06
Call successful
Other
2022-10-06
Call successful
Other
2022-10-06
Call successful
Other

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-13	Pfizer-BioNTech	No
2	2021-04-03	Pfizer-BioNTech	No
3	2021-10-04	Pfizer-BioNTech	No

Call center

6 call center cases

6 successful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 9 — 6 months, dose 2, dependent

2021-10-02

Symptoms: His Memory is worse, and his Parkinsons Walk is also. His Liver problems make his brain functions unpredictable, especially when he doesnt eat properly, and take his medications. He has been throwing them up after taking, makes it worse.

Healthcare visit (other): Doctors appointments

Release 10 — days 1–6 daily, dose 3, dependent

2021-10-09

Systemic reaction (other): More problems walking than usual

2021-10-10

Systemic reaction (other): Better than yesterday, walking sometimes better sometimes not, Fatigue

Release 10 — day 7, dose 3, dependent

2021-10-13

Systemic reaction (other): Walking problems continuing, exhausted all the time, sleeping , grouchy, listing problem solving skills

Release 10 — day 14, dose 3, dependent

2021-10-24

Symptoms: Sleeping more caused mealtime to change. He skipped some of his Meds.

Release 10 — day 21, dose 3, dependent

2021-10-25

Symptoms: Walking and thinking worse. Trouble dressing himself and getting in and out of bed. He started Home Physical Therapy

Release 10 — day 28, dose 3, dependent

2021-11-01

Symptoms: Didn't feel well several days, didn't eat much, missed several doses of Lactulose and other medications. Had shaking and balanced problems after urinating. Now has home Health and Physical Therapy visits.

Release 10 — day 35, dose 3, dependent

2021-11-08

Symptoms: Confusion, dementia, falling, sleeping most of the time, is now Hospitalized, loss of bladder control, not eating or drinking anything. Hospital unable to get a stool sample to test

Release 10 — 3 months, dose 3, dependent

2022-01-03

Symptoms: Cloudy thinking, moved to Nursing Home from Hospital for Physical Therapy, Nausea, Throwing up, unsteady on his feet and falling. Increased Confusion, Depression, Withdrawn, shaking, less communication even for things he wants

Healthcare visit (other): Hospital then Nursing Home

Release 11 — 6 months, dose 3, dependent

2022-04-06

Symptoms: Complete Liver Failure, and intermittent trips between the Hospital and nursing home for not responding, when Ammonia levels in the blood are too high. Bed sores, limited function in multiple areas

Release 12 — 12 months, dose 3, dependent

Reports this person's death

2022-10-05

Symptoms: He Died

Healthcare visit (other): Nursing Home and Hospital

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	Hospitalisation	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Rehabilitation therapy	·	·	✓
SD	Ammonia increased	·	·	✓
SD	Balance disorder	·	·	✓
SD	Brain fog	·	·	✓
SD	Cerebral disorder	·	·	✓
SD	Communication disorder	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Confusional state	·	·	✓
SD	Death	·	·	✓
SD	Decreased appetite	·	·	✓
SD	Decubitus ulcer	·	·	✓
SD	Dementia	·	·	✓
SD	Depression	·	·	✓
SD	Fall	·	·	✓
SD	Gait disturbance	·	·	✓
SD	Hepatic failure	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Hypersomnia	·	·	✓
SD	Hypophagia	·	·	✓
SD	Loss of personal independence in daily activities	·	·	✓
SD	Malaise	·	·	✓
SD	Medical counselling	·	·	✓
SD	Mental impairment	·	·	✓
SD	Mobility decreased	·	·	✓
SD	Nausea	·	·	✓
SD	Parkinson's disease	·	·	✓
SD	Physiotherapy	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Rehabilitation therapy	·	·	✓
SD	Social avoidant behaviour	·	·	✓
SD	Tremor	·	·	✓
SD	Urinary incontinence	·	·	✓
SD	Vomiting	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Gait disturbance	·	·	✓
SRO	Irritability	·	·	✓
SRO	Somnolence	·	·	✓

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