AMY-18169-46174
2 vaccinations
1 coded response
22 check-ins
1 free-text entry
1 call case
- Sex
- Male
- Age at first dose
- 12-15
- ZIP prefix
- 949 / CA
- Registered
- 2021-10-17
- Relationship
- Child or adolescent in my care
- Guardian
- QQC-22646-56470
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-10-16
Dose 1 — Pfizer-BioNTech
-
2021-10-17
Registered in v-safe
-
2021-10-18
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Site: Pain · NoneAdult check-in
- 2021-10-19
- 2021-10-20
- 2021-10-21
- 2021-10-22
- 2021-10-25
- 2021-10-30
-
2021-11-06
Dose 2 — Pfizer-BioNTech
-
2021-11-06
Survey response — day 0, dose 2, dependentMedDRA: Immediate post-injection reaction, Loss of consciousness — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Systemic reaction (other): He passed out 10 minutes after getting his shot this time · Healthcare visit (other): He passed out at the shot clinic luckily so the nurses took care of him afterMedDRA releases: 2024-11 · check-in free text available
-
2021-11-06
Report sent to call center — day 0, dose 2, dependentGet care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2021-11-07
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Good · Site: Pain · NoneAdult check-in
- 2021-11-09
- 2021-11-10
- 2021-11-10
- 2021-11-11
- 2021-11-12
-
2021-11-12
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-11-13
- 2021-11-20
- 2021-11-29
- 2021-12-04
- 2021-12-11
- 2021-12-18
- 2022-02-05
- 2022-05-09
- 2022-11-06
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-10-16 | Pfizer-BioNTech | No |
| 2 | 2021-11-06 | Pfizer-BioNTech | No |
Call center
1 call center case
1 successful
Free text
Release 10 — day 0, dose 2, dependent
Systemic reaction (other): He passed out 10 minutes after getting his shot this time
Healthcare visit (other): He passed out at the shot clinic luckily so the nurses took care of him after
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 | Loss of consciousness | · | · | ✓ |
| SRO | Immediate post-injection reaction | · | · | ✓ |
| SRO | Loss of consciousness | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release