C63-16701-04032

2 vaccinations 5 coded responses 25 check-ins 5 free-text entries 3 call cases

Sex: Male
Age at first dose: 05-11
ZIP prefix: 787 / TX
Registered: 2021-11-12

Relationship: Child or adolescent in my care
Guardian: ZH2-15135-19981
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-11-12
Registered in v-safe
2021-11-12
Dose 1 — Pfizer-BioNTech
2021-11-12
Health check-in — day 0, dose 1, dependent
Feeling: Good · Site: Pain, Redness, Itching · Joint pains

Adult check-in
2021-11-13
Health check-in — days 1–6 daily, dose 1, dependent
Feeling: Good · Site: Pain · Fatigue or tiredness, Nausea

Adult check-in
2021-11-14
Survey response — days 1–6 daily, dose 1, dependent
MedDRA: Cough, Respiratory tract congestion — Feeling: Good · Site: Pain · Fever · Fatigue or tiredness, Abdominal pain

Free text: Moderate cough (since 11/13 - persistent, mostly dry), congestion

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Survey response — days 1–6 daily, dose 1, dependent
MedDRA: Bronchitis, Nasal congestion, Office visit — Feeling: Fair · Fever · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Bronchitis (diagnosed by pediatrician) nasal congestion

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Report sent to call center — days 1–6 daily, dose 1, dependent
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-17
Survey response — days 1–6 daily, dose 1, dependent
MedDRA: Diarrhoea — Feeling: Poor · Fever · Chills, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Loose stool

MedDRA releases: 2024-11 · check-in free text available
2021-11-17
Report sent to call center — days 1–6 daily, dose 1, dependent
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-11-19
Survey response — day 7, dose 1, dependent
MedDRA: Bronchitis, Cough, Gastroenteritis viral, Nasal congestion, Respiratory tract congestion — Feeling: Fair · Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Dealing with bronchitis (cough with chest and nasal congestion), getting over stomach virus

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Call successful
Does not wish to fill out VAERS report
2021-11-19
Call successful
Does not wish to fill out VAERS report
2021-11-26
Health check-in — day 14, dose 1, dependent
Feeling: Good

Adult check-in
2021-12-03
Survey response — day 21, dose 1, dependent
MedDRA: Abdominal pain upper, Pyrexia, Urticaria — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Stomach ache with patchy urticaria on underarms, chest, back, neck, hips, groin, inner thighs, and some on head, face, wrists, behind knees 11/28-11/30 with 101.1 fever night of 11/30.

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Report sent to call center — day 21, dose 1, dependent
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-08
Call 1 — Left Voicemail
2021-12-10
Health check-in — day 28, dose 1, dependent
Feeling: Good

Adult check-in
2021-12-17
Health check-in — day 35, dose 1, dependent
Feeling: Good

Adult check-in
2021-12-24
Health check-in — day 42, dose 1, dependent
Feeling: Good

Adult check-in
2021-12-31
Dose 2 — Pfizer-BioNTech
2021-12-31
Health check-in — day 0, dose 2, dependent
Feeling: Good · Site: Pain · None

Adult check-in
2022-01-01
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · Site: Pain · None

Adult check-in
2022-01-02
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · Site: Pain · None

Adult check-in
2022-01-04
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · Site: Pain · None

Adult check-in
2022-01-05
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · None

Adult check-in
2022-01-07
Health check-in — day 7, dose 2, dependent
Feeling: Good · Abdominal pain

Adult check-in
2022-01-14
Health check-in — day 14, dose 2, dependent
Feeling: Good

Adult check-in
2022-01-21
Health check-in — day 21, dose 2, dependent
Feeling: Good

Adult check-in
2022-01-28
Health check-in — day 28, dose 2, dependent
Feeling: Good

Adult check-in
2022-02-05
Health check-in — day 35, dose 2, dependent
Feeling: Good

Adult check-in
2022-02-11
Health check-in — day 42, dose 2, dependent
Feeling: Good

Adult check-in
2022-04-01
Health check-in — 3 months, dose 2, dependent
Feeling: Good

Adult check-in
2022-07-01
Health check-in — 6 months, dose 2, dependent
Feeling: Good

Adult check-in
2022-12-31
Health check-in — 12 months, dose 2, dependent
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-11-12	Pfizer-BioNTech	No
2	2021-12-31	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-11-16	Successful 2021-11-19	Does not wish to fill out VAERS report
2021-11-17	Successful 2021-11-19	Does not wish to fill out VAERS report
2021-12-03	Unsuccessful

Free text

Release 10 — days 1–6 daily, dose 1, dependent

2021-11-14

Systemic reaction (other): Moderate cough (since 11/13 - persistent, mostly dry), congestion

2021-11-16

Systemic reaction (other): Bronchitis (diagnosed by pediatrician) nasal congestion

2021-11-17

Systemic reaction (other): Loose stool

Release 10 — day 7, dose 1, dependent

2021-11-19

Systemic reaction (other): Dealing with bronchitis (cough with chest and nasal congestion), getting over stomach virus

Release 10 — day 21, dose 1, dependent

2021-12-03

Symptoms: Stomach ache with patchy urticaria on underarms, chest, back, neck, hips, groin, inner thighs, and some on head, face, wrists, behind knees 11/28-11/30 with 101.1 fever night of 11/30.

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	Abdominal pain upper	·	·	✓
SD	Pyrexia	·	·	✓
SD	Urticaria	·	·	✓
SRO	Bronchitis	·	·	✓
SRO	Cough	·	·	✓
SRO	Diarrhoea	·	·	✓
SRO	Gastroenteritis viral	·	·	✓
SRO	Nasal congestion	·	·	✓
SRO	Office visit	·	·	✓
SRO	Respiratory tract congestion	·	·	✓

✓ active code · ○ coded but marked inactive · blank = not in that release