U28-48189-97833
3 vaccinations
2 coded responses
29 check-ins
2 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 05-11
- ZIP prefix
- 231 / VA
- Registered
- 2021-11-06
- Relationship
- Child or adolescent in my care
- Guardian
- LTM-16667-36318
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-11-06
Registered in v-safe
-
2021-11-06
Dose 1 — Pfizer-BioNTech
- 2021-11-06
- 2021-11-07
- 2021-11-08
- 2021-11-09
-
2021-11-11
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Fair · Fever · None · Be unable to work or attend schoolAdult check-in
-
2021-11-13
Survey response — day 7, dose 1, dependentMedDRA: Cough — Feeling: Fair · Fever · Fatigue or tirednessFree text: CoughMedDRA releases: 2024-11 · check-in free text available
- 2021-11-20
-
2021-11-27
Dose 2 — Pfizer-BioNTech
-
2021-11-27
Health check-in — day 0, dose 2, dependentFeeling: Good · Site: Pain, Redness · NoneAdult check-in
- 2021-11-28
- 2021-11-29
- 2021-12-01
- 2021-12-02
- 2021-12-03
- 2021-12-04
- 2021-12-11
- 2021-12-18
- 2021-12-26
- 2022-01-01
- 2022-01-08
- 2022-02-26
-
2022-05-28
Survey response — 6 months, dose 2, dependentMedDRA: Conjunctivitis, Cough, Ear infection, Laryngitis, Office visit, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Ear infection, pink eye, laryngitis, cough (multiple Covid negative tests) · Healthcare visit (other): PediatricianMedDRA releases: 2024-11 · check-in free text available
-
2022-05-28
Report sent to call center — 6 months, 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 pr1 call case(s)
-
2022-06-01
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-06-12
Dose 3 — Pfizer-BioNTech
- 2022-06-20
- 2022-06-26
- 2022-07-03
- 2022-07-10
- 2022-07-17
- 2022-07-24
- 2022-09-11
- 2022-12-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-11-06 | Pfizer-BioNTech | No |
| 2 | 2021-11-27 | Pfizer-BioNTech | No |
| 3 | 2022-06-12 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-05-28 | Successful 2022-06-01 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 10 — day 7, dose 1, dependent
Systemic reaction (other): Cough
Release 11 — 6 months, dose 2, dependent
Symptoms: Ear infection, pink eye, laryngitis, cough (multiple Covid negative tests)
Healthcare visit (other): Pediatrician
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 |
|---|---|---|---|---|
| HCVO | Office visit | · | · | ✓ |
| SD | Conjunctivitis | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Ear infection | · | · | ✓ |
| SD | Laryngitis | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Cough | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release