CJB-36096-04990
2 vaccinations
3 coded responses
23 check-ins
3 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 05-11
- ZIP prefix
- 971 / OR
- Registered
- 2021-12-04
- Relationship
- Child or adolescent in my care
- Guardian
- ZBJ-33811-81473
- Race
- Multiracial
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-12-04
Registered in v-safe
-
2021-12-04
Dose 1 — Pfizer-BioNTech
- 2021-12-04
-
2021-12-05
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Site: Pain · NoneAdult check-in
- 2021-12-06
- 2021-12-07
- 2021-12-09
- 2021-12-11
- 2021-12-21
-
2022-01-03
Survey response — day 28, dose 1, dependentMedDRA: Norovirus infection — Feeling: Good · Be unable to do your normal daily activitiesFree text: Had norovirusMedDRA releases: 2024-11 · check-in free text available
-
2022-01-08
Dose 2 — Pfizer-BioNTech
- 2022-01-08
-
2022-01-09
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Fair · Site: Pain · HeadacheAdult check-in
- 2022-01-10
- 2022-01-11
- 2022-01-12
- 2022-01-13
- 2022-01-14
- 2022-01-17
- 2022-01-24
- 2022-01-29
-
2022-02-05
Survey response — day 28, dose 2, dependentMedDRA: Croup infectious, Dyspnoea — Feeling: Poor · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: He had a quick onset of croup and couldn't breatheMedDRA releases: 2024-11 · check-in free text available
-
2022-02-05
Report sent to call center — day 28, dose 2, dependentBe unable to do their normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
-
2022-02-08
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-02-12
Survey response — day 35, dose 2, dependentMedDRA: Rhinorrhoea — Feeling: Good · Be unable to work or attend schoolFree text: Runny noseMedDRA releases: 2024-11 · check-in free text available
- 2022-02-19
- 2022-04-10
- 2022-07-12
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-12-04 | Pfizer-BioNTech | No |
| 2 | 2022-01-08 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-02-05 | Successful 2022-02-08 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 10 — day 28, dose 1, dependent
Symptoms: Had norovirus
Release 11 — day 28, dose 2, dependent
Symptoms: He had a quick onset of croup and couldn't breathe
Release 11 — day 35, dose 2, dependent
Symptoms: Runny nose
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 | Croup infectious | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Norovirus infection | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release