57Z-25849-80961
5 vaccinations
7 coded responses
42 check-ins
7 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 782 / TX
- Registered
- 2021-01-16
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-16
Registered in v-safe
-
2021-01-16
Dose 1 — Pfizer-BioNTech
-
2021-01-16
Survey response — day 0, dose 1MedDRA: No adverse event — Feeling: GoodFree text: Not so far.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-17
Health check-in — days 1–6 daily, dose 1Feeling: Good · Muscle or body aches, Rash, not including the immediate area around the injection siteAdult check-in
- 2021-01-18
- 2021-01-19
-
2021-01-21
Survey response — days 1–6 daily, dose 1MedDRA: Musculoskeletal stiffness, Neck pain — Feeling: Good · Muscle or body achesFree text: Stiff, sore neckMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-22
Survey response — days 1–6 daily, dose 1MedDRA: Neck pain, Pain in extremity — Feeling: Good · Muscle or body achesFree text: Neck still aches but much better today. Slight pain in left leg. Mainly in morning. Mostly gone now.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-23
- 2021-01-30
-
2021-02-06
Dose 2 — Pfizer-BioNTech
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-11
- 2021-02-12
- 2021-02-13
- 2021-02-20
- 2021-02-27
- 2021-03-06
- 2021-03-13
- 2021-03-20
- 2021-05-08
- 2021-08-07
-
2021-09-28
Dose 3 — Pfizer-BioNTech
- 2021-09-30
- 2021-10-01
- 2021-10-02
- 2021-10-03
- 2021-10-04
- 2021-10-05
- 2021-10-12
- 2021-10-19
- 2021-10-26
- 2021-11-02
- 2021-11-09
- 2021-12-28
- 2022-03-29
-
2022-04-01
Dose 4 — Pfizer-BioNTech
-
2022-04-15
Survey response — day 14, dose 4MedDRA: Dementia with Lewy bodies — Feeling: Good · Be unable to do your normal daily activitiesFree text: I have been diagnosed with Dementia with Lewy Bodies by my neurologist Dr. (b)(6) at (b)(6). I do not think that is related to the the Covid virus. I feel good right now but understand that will change as the disease progresses.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-22
Survey response — day 21, dose 4MedDRA: Dementia with Lewy bodies, Office visit, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Doctor says That I most likely have Lewy bodies dementia · Healthcare visit (other): MRI of BrainMedDRA releases: 2024-11 · check-in free text available
-
2022-04-22
Report sent to call center — day 21, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2022-04-25
-
2022-04-26
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-04-29
- 2022-05-06
- 2022-05-13
-
2022-07-01
Survey response — 3 months, dose 4MedDRA: COVID-19, Chills, Pyrexia, Quarantine, SARS-CoV-2 test positive — Feeling: GoodFree text: Covid- Dr prescribed Fluvoxamine for 10 days. Quarantined for 5days then continued wearing mask for 5 more days. Symptoms lasted for 1.5 days after starting meds. I never really felt bad. Tested positive when symptoms first appeared (fever, chills, hMedDRA releases: 2024-11 · check-in free text available
-
2022-09-23
Dose 5 — Pfizer-BioNTech
-
2022-10-02
Survey response — 6 months, dose 4MedDRA: Chills, Headache, Laboratory test abnormal, Medical counselling, Pyrexia — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Positive home test. Fever, chills and headache. · Healthcare visit (other): PhoneMedDRA releases: 2024-11 · check-in free text available
-
2022-10-02
Report sent to call center — 6 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
- 2022-10-04
- 2022-10-05
-
2022-10-05
Callback requested for10:15AM ET
-
2022-10-05
Call successfulDoes not wish to fill out VAERS report
- 2023-04-01
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-16 | Pfizer-BioNTech | |
| 2 | 2021-02-06 | Pfizer-BioNTech | |
| 3 | 2021-09-28 | Pfizer-BioNTech | No |
| 4 | 2022-04-01 | Pfizer-BioNTech | No |
| 5 | 2022-09-23 | Pfizer-BioNTech | No |
Call center
2 call center cases
2 successful
Free text
Release 2 — day 0, dose 1
Systemic reaction (other): Not so far.
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): Stiff, sore neck
Systemic reaction (other): Neck still aches but much better today. Slight pain in left leg. Mainly in morning. Mostly gone now.
Release 11 — day 14, dose 4
Symptoms: I have been diagnosed with Dementia with Lewy Bodies by my neurologist Dr. (b)(6) at (b)(6). I do not think that is related to the the Covid virus. I feel good right now but understand that will change as the disease progresses.
redacted (b)(6)
Release 11 — day 21, dose 4
Symptoms: Doctor says That I most likely have Lewy bodies dementia
Healthcare visit (other): MRI of Brain
Release 12 — 3 months, dose 4
Symptoms: Covid- Dr prescribed Fluvoxamine for 10 days. Quarantined for 5days then continued wearing mask for 5 more days. Symptoms lasted for 1.5 days after starting meds. I never really felt bad. Tested positive when symptoms first appeared (fever, chills, h cut off by CDC
Release 12 — 6 months, dose 4
Symptoms: Positive home test. Fever, chills and headache.
Healthcare visit (other): Phone
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 | Medical counselling | · | · | ✓ |
| HCVO | Unevaluable event | · | · | ✓ |
| SD | Chills | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Dementia with Lewy bodies | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Laboratory test abnormal | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Quarantine | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Musculoskeletal stiffness | ✓ | ✓ | ✓ |
| SRO | Neck pain | ✓ | ✓ | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release