E49-19096-22655
2 vaccinations
2 coded responses
2 check-ins
2 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 12-15
- ZIP prefix
- 104 / NY
- Registered
- 2021-10-30
- Relationship
- Child or adolescent in my care
- Guardian
- 6EU-51801-98894
- Race
- Multiracial
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-09-21
Dose 1 — Pfizer-BioNTech
-
2021-10-13
Dose 2 — Pfizer-BioNTech
-
2021-10-30
Registered in v-safe
-
2021-10-30
Survey response — day 14, dose 2, dependentMedDRA: Abdominal pain upper, Diarrhoea, Headache, Nausea, Pyrexia — 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 · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: Severe stomach nausea, pain, diarrhea. Headache, high fever both days. Still has stomach pains and diarrheaMedDRA releases: 2024-11 · check-in free text available
-
2021-10-30
Report sent to call center — day 14, 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 prOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
- 2021-11-02
- 2021-11-05
-
2022-10-15
Survey response — 12 months, dose 2, dependentMedDRA: Asthma, Pre-existing disease — Feeling: FairFree text: Trouble with his controlled asthma he's on medications for it.MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-09-21 | Pfizer-BioNTech | No |
| 2 | 2021-10-13 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-10-30 | Unsuccessful |
Free text
Release 10 — day 14, dose 2, dependent
Symptoms: Severe stomach nausea, pain, diarrhea. Headache, high fever both days. Still has stomach pains and diarrhea
Release 12 — 12 months, dose 2, dependent
Symptoms: Trouble with his controlled asthma he's on medications for it.
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 | Asthma | · | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release