55Z-25295-03017
4 vaccinations
4 coded responses
50 check-ins
4 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 05-11
- ZIP prefix
- 525 / IA
- Registered
- 2021-11-08
- Relationship
- Child or adolescent in my care
- Guardian
- YXM-21869-36438
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-11-08
Registered in v-safe
-
2021-11-08
Dose 1 — Pfizer-BioNTech
- 2021-11-08
-
2021-11-09
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Site: Pain, Redness, Swelling · Fever · Headache, Fatigue or tirednessAdult check-in
-
2021-11-10
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Site: Redness · NoneAdult check-in
-
2021-11-11
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Fair · Fever · Chills, Headache, Fatigue or tirednessAdult check-in
- 2021-11-12
- 2021-11-13
- 2021-11-14
- 2021-11-15
- 2021-11-22
-
2021-11-29
Dose 2 — Pfizer-BioNTech
-
2021-11-29
Health check-in — day 0, dose 2, dependentFeeling: Good · Site: Pain, Redness · Fever · NoneAdult check-in
- 2021-11-30
- 2021-12-01
- 2021-12-02
- 2021-12-03
- 2021-12-04
- 2021-12-05
- 2021-12-06
- 2021-12-13
- 2021-12-20
- 2021-12-27
- 2022-01-03
- 2022-01-10
-
2022-02-28
Survey response — 3 months, dose 2, dependentMedDRA: SARS-CoV-2 test negative, Upper respiratory tract infection — Feeling: Fair · Be unable to work or attend schoolFree text: He has an upper respiratory infection. Test results conclude it's not Covid-19MedDRA releases: 2024-11 · check-in free text available
-
2022-05-27
Dose 3 — Pfizer-BioNTech
- 2022-05-30
- 2022-05-30
- 2022-05-31
- 2022-06-01
- 2022-06-02
- 2022-06-03
- 2022-06-10
-
2022-06-17
Survey response — day 21, dose 3, dependentMedDRA: Ankle fracture — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: He broke his ankle. No correlation to his recent booster vaccineMedDRA releases: 2024-11 · check-in free text available
-
2022-06-17
Report sent to call center — day 21, dose 3, dependentBe unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prEmergency room or emergency department visit · 1 call case(s)
-
2022-06-21
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-06-24
- 2022-07-01
- 2022-07-08
- 2022-08-26
-
2022-11-07
Dose 4 — Pfizer-BioNTechCo-administered: Flu
- 2022-11-07
-
2022-11-08
Survey response — days 1–6 daily, dose 4, dependentMedDRA: Feeling hot, Malaise — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tirednessFree text: He just felt unwell. No fever, but felt like he had one.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-09
Health check-in — days 1–6 daily, dose 4, dependentFeeling: Good · Fatigue or tirednessAdult check-in
- 2022-11-10
- 2022-11-11
- 2022-11-12
- 2022-11-13
- 2022-11-14
- 2022-11-21
- 2022-11-28
-
2022-12-05
Survey response — day 28, dose 4, dependentMedDRA: Cough, Oropharyngeal pain — Feeling: Fair · Be unable to work or attend schoolFree text: Sore throat, coughMedDRA releases: 2024-11 · check-in free text available
- 2022-12-12
- 2022-12-19
- 2023-02-06
- 2023-05-09
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-11-08 | Pfizer-BioNTech | No |
| 2 | 2021-11-29 | Pfizer-BioNTech | No |
| 3 | 2022-05-27 | Pfizer-BioNTech | No |
| 4 | 2022-11-07 | Pfizer-BioNTech | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-06-17 | Successful 2022-06-21 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 11 — 3 months, dose 2, dependent
Symptoms: He has an upper respiratory infection. Test results conclude it's not Covid-19
Release 12 — day 21, dose 3, dependent
Symptoms: He broke his ankle. No correlation to his recent booster vaccine
Release 12 — days 1–6 daily, dose 4, dependent
Systemic reaction (other): He just felt unwell. No fever, but felt like he had one.
Release 12 — day 28, dose 4, dependent
Symptoms: Sore throat, cough
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 | Ankle fracture | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Upper respiratory tract infection | · | · | ✓ |
| SRO | Feeling hot | · | · | ✓ |
| SRO | Malaise | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release