VA9-28178-58629
4 vaccinations
3 coded responses
34 check-ins
3 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 902 / CA
- Registered
- 2020-12-23
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-23
Registered in v-safe
-
2020-12-23
Dose 1 — Pfizer-BioNTech
- 2020-12-23
-
2020-12-26
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: Good · Site: PainMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2020-12-27
- 2020-12-28
- 2020-12-29
- 2020-12-30
- 2021-01-06
-
2021-01-13
Dose 2 — Pfizer-BioNTech
- 2021-01-13
- 2021-01-14
- 2021-01-15
- 2021-01-16
- 2021-01-17
- 2021-01-18
- 2021-01-19
- 2021-01-20
- 2021-01-27
- 2021-02-03
- 2021-02-10
- 2021-02-17
- 2021-02-24
-
2021-04-14
Survey response — 3 month, dose 2MedDRA: Dyspnoea, Supraventricular extrasystoles — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-04-14
Report sent to call center — 3 month, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-07-14
-
2021-09-30
Dose 3 — Pfizer-BioNTech
- 2022-01-13
-
2022-03-25
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-04-15
Dose 4 — Moderna
- 2022-04-19
- 2022-04-20
- 2022-04-21
- 2022-04-22
- 2022-04-29
- 2022-05-06
- 2022-05-15
- 2022-05-20
- 2022-05-27
-
2022-07-15
Survey response — 3 month, dose 4MedDRA: COVID-19, SARS-CoV-2 test positive — 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 professional · Telehealth, virtual health, or email health consultationMedDRA releases: 2024-11 · check-in answers available
-
2022-07-15
Report sent to call center — 3 month, dose 4Be 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 · 1 call case(s)
-
2022-07-18
Call successfulParticipant prefers to complete VAERS report online
- 2023-04-15
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-23 | Pfizer-BioNTech | |
| 2 | 2021-01-13 | Pfizer-BioNTech | |
| 3 | 2021-09-30 | Pfizer-BioNTech | No |
| 4 | 2022-04-15 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-04-14 | Successful 2022-03-25 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2022-07-15 | Successful 2022-07-18 |
Participant prefers to complete VAERS report online |
Free text
Release 1
Systemic reaction (other): Site pain day after injection. None since.
Release 7
Symptoms: Ive had some shortness of breath on exertion at times but at other times able to jog for 30 minutes without any difficulty. I have had atrial ectopic beats. I saw a cardiologist who said he heard a friction rub. Im getting at echocardiogram 4
Release 12
Symptoms: Covid June 6. Rebound symptoms and positive test on June 14, 2022
Free-text releases are not linked to a specific 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 | COVID-19 | · | · | ✓ |
| SD | Dyspnoea | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Supraventricular extrasystoles | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release