6QX-24211-79222
3 vaccinations
8 coded responses
11 check-ins
8 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 847 / UT
- Registered
- 2021-10-11
- Relationship
- Self
- Race
- White
- Ethnicity
- N/A
Timeline
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2021-01-13
Dose 1 — Pfizer-BioNTech
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2021-02-03
Dose 2 — Pfizer-BioNTech
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2021-10-07
Dose 3 — Pfizer-BioNTech
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2021-10-11
Registered in v-safe
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2021-10-11
Survey response — days 1–6 daily, dose 3MedDRA: Bell's palsy — Feeling: Poor · Muscle or body achesFree text: Bells palsyMedDRA releases: 2024-11 · check-in free text available
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2021-10-12
Survey response — days 1–6 daily, dose 3MedDRA: Pain, Pre-existing disease — Feeling: Poor · Muscle or body achesFree text: It hurts bad where I had shingles many years ago.MedDRA releases: 2024-11 · check-in free text available
- 2021-10-13
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2021-10-14
Survey response — day 7, dose 3MedDRA: Arthralgia, Bell's palsy, Condition aggravated, Neck pain, Pre-existing disease — Feeling: Poor · Site: Pain, Swelling, Itching · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection siteFree text: Bells palsy, and extreme pain in my shoulder and neck where I had shingles 35 years ago. Never had a problem with it until I got the booster shot !MedDRA releases: 2024-11 · check-in free text available
- 2021-10-21
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2021-10-28
Survey response — day 21, dose 3MedDRA: Herpes simplex, Pre-existing disease — Feeling: PoorFree text: Since the booster shot my shingles have been getting progressively worse. Haven't had a problem with them for 25 years until the booster shot.MedDRA releases: 2024-11 · check-in free text available
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2021-11-04
Survey response — day 28, dose 3MedDRA: Arthralgia, Bell's palsy — Feeling: PoorFree text: Severe pain in Left shoulder. Bells palsy is getting worse.MedDRA releases: 2024-11 · check-in free text available
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2021-11-11
Survey response — day 35, dose 3MedDRA: Arthralgia — Feeling: PoorFree text: Shoulder is very sore.MedDRA releases: 2024-11 · check-in free text available
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2021-11-18
Survey response — day 42, dose 3MedDRA: Skin ulcer — Feeling: PoorFree text: Sores have appeared on my left buttocksMedDRA releases: 2024-11 · check-in free text available
- 2022-01-10
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2022-04-07
Survey response — 6 months, dose 3MedDRA: Bell's palsy, Herpes zoster — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: Shingles and Bell's palsyMedDRA releases: 2024-11 · check-in free text available
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2022-04-07
Report sent to call center — 6 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
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2022-04-12
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-13 | Pfizer-BioNTech | No |
| 2 | 2021-02-03 | Pfizer-BioNTech | No |
| 3 | 2021-10-07 | Pfizer-BioNTech | No |
Call center
1 call center case
1 successful
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Bells palsy
Systemic reaction (other): It hurts bad where I had shingles many years ago.
Release 10 — day 7, dose 3
Systemic reaction (other): Bells palsy, and extreme pain in my shoulder and neck where I had shingles 35 years ago. Never had a problem with it until I got the booster shot !
Release 10 — day 21, dose 3
Symptoms: Since the booster shot my shingles have been getting progressively worse. Haven't had a problem with them for 25 years until the booster shot.
Release 10 — day 28, dose 3
Symptoms: Severe pain in Left shoulder. Bells palsy is getting worse.
Release 10 — day 35, dose 3
Symptoms: Shoulder is very sore.
Release 10 — day 42, dose 3
Symptoms: Sores have appeared on my left buttocks
Release 11 — 6 months, dose 3
Symptoms: Shingles and Bell's palsy
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 | Arthralgia | · | · | ✓ |
| SD | Bell's palsy | · | · | ✓ |
| SD | Herpes simplex | · | · | ✓ |
| SD | Herpes zoster | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Skin ulcer | · | · | ✓ |
| SRO | Arthralgia | · | · | ✓ |
| SRO | Bell's palsy | · | · | ✓ |
| SRO | Condition aggravated | · | · | ✓ |
| SRO | Neck pain | · | · | ✓ |
| SRO | Pain | · | · | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release