BXR-11934-30243
3 vaccinations
4 coded responses
21 check-ins
4 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 534 / WI
- Registered
- 2021-01-21
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-20
Dose 1 — Pfizer-BioNTech
-
2021-01-21
Registered in v-safe
-
2021-01-21
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: GoodFree text: NoneMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-22
- 2021-01-24
- 2021-01-26
- 2021-01-28
- 2021-02-03
-
2021-02-10
Dose 2 — Pfizer-BioNTech
- 2021-03-05
- 2021-03-10
- 2021-03-17
- 2021-03-25
- 2021-05-12
-
2021-08-13
Survey response — 6 months, dose 2MedDRA: Ectopic atrial rhythm — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Ectopic Atrial RythwmMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-13
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-23
-
2021-09-21
Dose 3 — Moderna
- 2021-09-30
- 2021-10-05
- 2021-10-18
- 2021-10-19
- 2021-10-26
- 2021-11-02
- 2021-12-21
-
2022-03-22
Survey response — 6 months, dose 3MedDRA: Atypical pneumonia — Feeling: GoodFree text: Ambulatory Penumonia. Currently being treated with antibiotics. Prognosis, full recovery.MedDRA releases: 2024-11 · check-in free text available
-
2022-09-21
Survey response — 12 months, dose 3MedDRA: Office visit, Urinary tract infection — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: UTI · Healthcare visit (other): Dr office visitMedDRA releases: 2024-11 · check-in free text available
-
2022-09-21
Report sent to call center — 12 months, dose 3Get care from a doctor or other healthcare professional1 call case(s)
- 2022-09-22
- 2022-09-22
-
2022-09-22
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-09-22
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-20 | Pfizer-BioNTech | |
| 2 | 2021-02-10 | Pfizer-BioNTech | |
| 3 | 2021-09-21 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-08-13 | Successful 2022-09-22 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-09-21 | Successful 2022-09-22 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): None
Release 9 — 6 months, dose 2
Symptoms: Ectopic Atrial Rythwm
Release 11 — 6 months, dose 3
Symptoms: Ambulatory Penumonia. Currently being treated with antibiotics. Prognosis, full recovery.
Release 12 — 12 months, dose 3
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 | Office visit | · | · | ✓ |
| SD | Atypical pneumonia | · | · | ✓ |
| SD | Ectopic atrial rhythm | ✓ | · | ✓ |
| SD | Urinary tract infection | · | · | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release