67Z-10402-07150
5 vaccinations
4 coded responses
47 check-ins
3 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 985 / WA
- Registered
- 2021-01-30
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-30
Registered in v-safe
-
2021-01-30
Dose 1 — Pfizer-BioNTech
-
2021-02-23
Dose 2 — Pfizer-BioNTech
- 2021-02-24
- 2021-02-25
- 2021-02-26
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
-
2021-04-06
Survey response — day 42, dose 2MedDRA: Herpes simplex, Pre-existing disease, Stress — Feeling: GoodFree text: Having a herpatic episode at the outside corner of my left eye,started yesterday morning,took 800.mg of Zovirax, took same today this is the usual location when activated ,stress related,Thursday I had to put my dog down,In the past the Zovirax had hMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-25
- 2021-08-24
-
2021-09-30
Dose 3 — Pfizer-BioNTech
- 2021-10-01
- 2021-10-02
- 2021-10-05
- 2021-10-06
- 2021-10-07
- 2021-10-16
- 2021-10-21
- 2021-10-28
- 2021-11-04
- 2021-11-11
- 2022-01-01
-
2022-03-31
Dose 4 — Moderna
- 2022-03-31
- 2022-04-14
- 2022-04-21
- 2022-04-28
- 2022-05-05
- 2022-05-12
-
2022-06-30
Survey response — 3 months, dose 4MedDRA: Chest discomfort, Cough, Productive cough — Feeling: GoodFree text: Slight upper cough with some chest tightening, hard to expel phlegm, lasted ahout a week,tested twice by (b)(6) County Mall site,I'm attributing the coughing to molds or pollen,all better nowMedDRA releases: 2024-11 · check-in free text available
- 2022-09-29
-
2022-10-19
Dose 5 — ModernaCo-administered: Flu
-
2022-10-19
Survey response — day 0, dose 5MedDRA: Feeling hot, Flushing — Feeling: Fair · Fever · ChillsFree text: Warming, feeling slightly flushedMedDRA releases: 2024-11 · check-in free text available
-
2022-10-20
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Pain · Fever · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-10-21
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Pain · Chills, Fatigue or tirednessAdult check-in
- 2022-10-22
- 2022-10-23
- 2022-10-25
- 2022-10-26
- 2022-11-03
- 2022-11-09
- 2022-11-18
- 2022-11-23
- 2022-11-30
- 2023-01-18
-
2023-04-19
Survey response — 6 months, dose 5MedDRA: Cough, Oropharyngeal pain — Feeling: GoodMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-30 | Pfizer-BioNTech | |
| 2 | 2021-02-23 | Pfizer-BioNTech | |
| 3 | 2021-09-30 | Pfizer-BioNTech | No |
| 4 | 2022-03-31 | Moderna | No |
| 5 | 2022-10-19 | Moderna | Flu |
Free text
Release 7 — day 42, dose 2
Symptoms: Having a herpatic episode at the outside corner of my left eye,started yesterday morning,took 800.mg of Zovirax, took same today this is the usual location when activated ,stress related,Thursday I had to put my dog down,In the past the Zovirax had h cut off by CDC
Release 12 — 3 months, dose 4
Symptoms: Slight upper cough with some chest tightening, hard to expel phlegm, lasted ahout a week,tested twice by (b)(6) County Mall site,I'm attributing the coughing to molds or pollen,all better now
redacted (b)(6)
Release 12 — day 0, dose 5
Systemic reaction (other): Warming, feeling slightly flushed
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 | Chest discomfort | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Herpes simplex | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Productive cough | · | · | ✓ |
| SD | Stress | ✓ | ✓ | ✓ |
| SRO | Feeling hot | · | · | ✓ |
| SRO | Flushing | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release