HP4-23314-93282

4 vaccinations 8 coded responses 21 check-ins 7 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 119 / NY
Registered: 2021-09-10

Relationship: Adult relative or friend
Guardian: 2JH-33432-17085
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-21
Dose 1 — Pfizer-BioNTech
2021-03-14
Dose 2 — Pfizer-BioNTech
2021-08-30
Dose 3 — Pfizer-BioNTech
2021-09-10
Registered in v-safe
2021-09-10
Health check-in — day 7, dose 3, dependent
Feeling: Good · None · Be unable to do their normal daily activities

Adult check-in
2021-09-14
Health check-in — day 14, dose 3, dependent
Feeling: Fair

Adult check-in
2021-09-21
Health check-in — day 21, dose 3, dependent
Feeling: Good

Adult check-in
2021-09-27
Health check-in — day 28, dose 3, dependent
Feeling: Good

Adult check-in
2021-10-05
Health check-in — day 35, dose 3, dependent
Feeling: Good

Adult check-in
2021-10-11
Health check-in — day 42, dose 3, dependent
Feeling: Poor

Adult check-in
2021-11-29
Survey response — 3 months, dose 3, dependent
MedDRA: Hospitalisation, Mitral valve disease, Renal failure, Tricuspid valve disease — Feeling: Poor · 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, Hospitalization

Free text: In hospital since Nov.24 & scheduled to undergo triple bypass open heart surgery Fri. Dec. 3. Also, replace leaking tricuspid valve & leaking mitral valve. In kidney failure.

MedDRA releases: 2024-11 · check-in free text available
2021-11-29
Report sent to call center — 3 months, dose 3, 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 · Hospitalization · 1 call case(s)
2021-12-01
Call 2 — Left Voicemail
2022-02-02
Dose 4 — Pfizer-BioNTech
2022-02-02
Health check-in — day 0, dose 4, dependent
Feeling: Good · None

Adult check-in
2022-02-03
Health check-in — days 1–6 daily, dose 4, dependent
Feeling: Poor · None

Adult check-in
2022-02-04
Health check-in — days 1–6 daily, dose 4, dependent
Feeling: Good · None

Adult check-in
2022-02-06
Health check-in — days 1–6 daily, dose 4, dependent
Feeling: Good · None

Adult check-in
2022-02-07
Health check-in — days 1–6 daily, dose 4, dependent
Feeling: Good · None

Adult check-in
2022-02-09
Health check-in — day 7, dose 4, dependent
Feeling: Good · None

Adult check-in
2022-02-16
Health check-in — day 14, dose 4, dependent
Feeling: Good

Adult check-in
2022-02-23
Survey response — day 21, dose 4, dependent
MedDRA: Schizophrenia — Feeling: Poor

Free text: Paranoid schizophrenia.

MedDRA releases: 2024-11 · check-in free text available
2022-03-02
Survey response — day 28, dose 4, dependent
MedDRA: Schizophrenia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Paranoid schizophrenia.

MedDRA releases: 2024-11 · check-in free text available
2022-03-09
Survey response — day 35, dose 4, dependent
MedDRA: Schizophrenia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Paranoid schizophrenia.

MedDRA releases: 2024-11 · check-in free text available
2022-03-16
Survey response — day 42, dose 4, dependent
MedDRA: Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities

Free text: Paranoid schizophrenia.

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
Survey response — 3 months, dose 4, dependent
MedDRA: Schizophrenia — Feeling: Poor

Free text: Severe paranoid schizophrenia.

MedDRA releases: 2024-11 · check-in free text available
2022-08-03
Survey response — 6 months, dose 4, dependent
MedDRA: Dementia, Schizophrenia — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Paranoid schizophrenia & dementia.

MedDRA releases: 2024-11 · check-in free text available
2023-02-02
Survey response — 12 months, dose 4, dependent
MedDRA: Cardiac failure, Hospitalisation, Pneumonia, Respiratory failure, Respiratory syncytial virus infection, Sepsis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

MedDRA releases: 2024-11
2023-02-02
Report sent to call center — 12 months, dose 4, dependent
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2023-02-03
Call 1 — Left Voicemail
2023-02-03
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-21	Pfizer-BioNTech	No
2	2021-03-14	Pfizer-BioNTech	No
3	2021-08-30	Pfizer-BioNTech	No
4	2022-02-02	Pfizer-BioNTech	No

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 10 — 3 months, dose 3, dependent

2021-11-29

Symptoms: In hospital since Nov.24 & scheduled to undergo triple bypass open heart surgery Fri. Dec. 3. Also, replace leaking tricuspid valve & leaking mitral valve. In kidney failure.

Release 11 — day 21, dose 4, dependent

2022-02-23

Symptoms: Paranoid schizophrenia.

Release 11 — day 28, dose 4, dependent

2022-03-02

Symptoms: Paranoid schizophrenia.

Release 11 — day 35, dose 4, dependent

2022-03-09

Symptoms: Paranoid schizophrenia.

Release 11 — day 42, dose 4, dependent

2022-03-16

Symptoms: Paranoid schizophrenia.

Release 11 — 3 months, dose 4, dependent

2022-05-04

Symptoms: Severe paranoid schizophrenia.

Release 12 — 6 months, dose 4, dependent

2022-08-03

Symptoms: Paranoid schizophrenia & dementia.

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	Cardiac failure	·	·	✓
SD	Dementia	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Mitral valve disease	·	·	✓
SD	Pneumonia	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Renal failure	·	·	✓
SD	Respiratory failure	·	·	✓
SD	Respiratory syncytial virus infection	·	·	✓
SD	Schizophrenia	·	·	✓
SD	Sepsis	·	·	✓
SD	Tricuspid valve disease	·	·	✓

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