577-23027-95333
4 vaccinations
4 coded responses
20 check-ins
4 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 070 / NJ
- Registered
- 2021-01-26
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-18
Dose 1 — Pfizer-BioNTech
-
2021-01-04
Dose 2 — Pfizer-BioNTech
-
2021-01-26
Registered in v-safe
-
2021-01-26
Survey response — day 21, dose 2MedDRA: Emergency care, Pyrexia, SARS-CoV-2 test negative, Tachycardia — Feeling: Good · 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 visitFree text: Fever of 101.7, rigors, tachycardia in the 130s on Jan 19 in the evening prompting an ER visit. My covid test was negative but rhinovirus positive (I had a cold Jan 15-17 but then felt fine until the above happened).MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-26
Report sent to call center — day 21, dose 2Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-02-01
- 2021-02-09
- 2021-02-15
- 2021-04-05
- 2021-06-07
- 2021-07-08
-
2021-09-14
Dose 3 — Pfizer-BioNTech
-
2021-09-30
Survey response — day 14, dose 3MedDRA: Mammogram abnormal, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Abnormal mammogram · Healthcare visit (other): Breast biopsyMedDRA releases: 2024-11 · check-in free text available
-
2021-09-30
Report sent to call center — day 14, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2021-10-01
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-10-07
- 2021-10-14
- 2021-10-19
-
2021-10-28
Survey response — day 42, dose 3MedDRA: Upper respiratory tract infection — Feeling: GoodFree text: Just a URIMedDRA releases: 2024-11 · check-in free text available
-
2021-12-14
Survey response — 3 months, dose 3MedDRA: Abortion spontaneous — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: MiscarriageMedDRA releases: 2024-11 · check-in free text available
-
2021-12-14
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2021-12-17
- 2022-03-17
-
2022-09-09
Dose 4 — Pfizer-BioNTech
- 2022-09-14
- 2022-09-30
- 2022-10-07
- 2022-10-14
- 2022-10-21
- 2022-12-09
- 2023-03-10
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-18 | Pfizer-BioNTech | |
| 2 | 2021-01-04 | Pfizer-BioNTech | |
| 3 | 2021-09-14 | Pfizer-BioNTech | No |
| 4 | 2022-09-09 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-01-26 | Successful | Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2021-09-30 | Successful 2021-10-01 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2021-12-14 | Unsuccessful |
Free text
Release 2 — day 21, dose 2
Symptoms: Fever of 101.7, rigors, tachycardia in the 130s on Jan 19 in the evening prompting an ER visit. My covid test was negative but rhinovirus positive (I had a cold Jan 15-17 but then felt fine until the above happened).
Release 9 — day 14, dose 3
Release 10 — day 42, dose 3
Symptoms: Just a URI
Release 10 — 3 months, dose 3
Symptoms: Miscarriage
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 | Unevaluable event | · | · | ✓ |
| SD | Abortion spontaneous | · | · | ✓ |
| SD | Emergency care | ✓ | ✓ | ✓ |
| SD | Mammogram abnormal | · | · | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | ✓ | ✓ | ✓ |
| SD | Tachycardia | ✓ | ✓ | ✓ |
| SD | Upper respiratory tract infection | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release