C8D-17419-50668
4 vaccinations
4 coded responses
31 check-ins
4 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 05-11
- ZIP prefix
- 805 / CO
- Registered
- 2021-11-05
- Relationship
- Child or adolescent in my care
- Guardian
- 9RC-13218-99926
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-11-05
Registered in v-safe
-
2021-11-05
Dose 1 — Pfizer-BioNTech
- 2021-11-05
-
2021-11-06
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Site: Pain · NoneAdult check-in
-
2021-11-07
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Site: Pain · Abdominal painAdult check-in
- 2021-11-10
- 2021-11-12
- 2021-11-19
-
2021-11-26
Dose 2 — Pfizer-BioNTech
- 2021-11-26
-
2021-11-27
Survey response — days 1–6 daily, dose 2, dependentMedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good · Site: PainFree text: Sore and swollen lymph nodes in armpit of the arm shot was given.MedDRA releases: 2024-11 · check-in free text available
-
2021-11-28
Survey response — days 1–6 daily, dose 2, dependentMedDRA: Lymphadenopathy — Feeling: Good · Site: PainFree text: Swollen lymph node in armpit of arm shot was received inMedDRA releases: 2024-11 · check-in free text available
- 2021-11-29
- 2021-12-01
- 2021-12-02
- 2021-12-03
- 2021-12-11
-
2021-12-17
Survey response — day 21, dose 2, dependentMedDRA: Cough, Pyrexia, Rash, Rhinorrhoea, SARS-CoV-2 test negative, Self-medication, Urticaria, Viral infection — Feeling: Fair · 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, Outpatient clinic or urgent care clinic visitFree text: Caught a virus of some sort: runny nose, coughing, fever and has experienced hives/rash covering majority of body for several days due to the virus, rash/hives are well controlled with Claritin and Benadryl. Had a PCR Covid test and it was negative.MedDRA releases: 2024-11 · check-in free text available
-
2021-12-17
Report sent to call center — day 21, dose 2, dependentBe unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
-
2021-12-21
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-12-24
- 2021-12-31
- 2022-01-09
- 2022-02-25
-
2022-05-27
Dose 3 — Pfizer-BioNTech
- 2022-05-27
-
2022-11-02
Dose 4 — ModernaCo-administered: Flu
-
2022-11-02
Health check-in — day 0, dose 4, dependentFeeling: Fair · Site: Pain, Redness · Fever · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2022-11-04
Survey response — days 1–6 daily, dose 4, dependentMedDRA: Influenza A virus test positive — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Jordan tested positive for influenza A.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-04
Report sent to call center — days 1–6 daily, dose 4, dependentBe unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-11-05
- 2022-11-06
- 2022-11-07
-
2022-11-07
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-11-11
- 2022-11-23
- 2022-11-30
- 2022-12-07
- 2022-12-15
- 2023-02-01
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-11-05 | Pfizer-BioNTech | No |
| 2 | 2021-11-26 | Pfizer-BioNTech | No |
| 3 | 2022-05-27 | Pfizer-BioNTech | No |
| 4 | 2022-11-02 | Moderna | Flu |
Call center
2 call center cases
2 successful
Free text
Release 10 — days 1–6 daily, dose 2, dependent
Systemic reaction (other): Sore and swollen lymph nodes in armpit of the arm shot was given.
Systemic reaction (other): Swollen lymph node in armpit of arm shot was received in
Release 10 — day 21, dose 2, dependent
Symptoms: Caught a virus of some sort: runny nose, coughing, fever and has experienced hives/rash covering majority of body for several days due to the virus, rash/hives are well controlled with Claritin and Benadryl. Had a PCR Covid test and it was negative. cut off by CDC
Release 12 — days 1–6 daily, dose 4, dependent
Systemic reaction (other): Jordan tested positive for influenza A.
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 | Cough | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Rash | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Self-medication | · | · | ✓ |
| SD | Urticaria | · | · | ✓ |
| SD | Viral infection | · | · | ✓ |
| SRO | Influenza A virus test positive | · | · | ✓ |
| SRO | Lymph node pain | · | · | ✓ |
| SRO | Lymphadenopathy | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release