Y2L-85054-79851

3 vaccinations 16 coded responses 28 check-ins 16 free-text entries 5 call cases

Sex: Male
Age at first dose: 05-11
ZIP prefix: 971 / OR
Registered: 2021-11-11

Relationship: Child or adolescent in my care
Guardian: 9PB-96345-07428
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-11-11
Registered in v-safe
2021-11-11
Dose 1 — Pfizer-BioNTech
2021-11-11
Health check-in — day 0, dose 1, dependent
Feeling: Good · None

Adult check-in
2021-11-12
Health check-in — days 1–6 daily, dose 1, dependent
Feeling: Fair · Fever · Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-11-13
Health check-in — days 1–6 daily, dose 1, dependent
Feeling: Good · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-11-14
Survey response — days 1–6 daily, dose 1, dependent
MedDRA: Brain fog — Feeling: Fair · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Severe Mental fog

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Survey response — days 1–6 daily, dose 1, dependent
MedDRA: Brain fog, Memory impairment — Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Mental fogginess and difficulty remembering/following directions

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Survey response — day 7, dose 1, dependent
MedDRA: Abnormal behaviour, Cognitive disorder — Feeling: Good · Site: Redness, Itching · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Behavioral and cognitive shifts

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Survey response — day 14, dose 1, dependent
MedDRA: Disturbance in attention, Restlessness — Feeling: Fair · Be unable to do your normal daily activities

Free text: Difficulty focusing and sitting still

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Survey response — day 21, dose 1, dependent
MedDRA: Behaviour disorder, Office visit, Pruritus — Feeling: Good · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Behavioral challenges, itchiness · Healthcare visit (other): PCP visit

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Report sent to call center — day 21, dose 1, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-04
Dose 2 — Pfizer-BioNTech
2021-12-08
Call 1 — Left Voicemail
2021-12-09
Survey response — days 1–6 daily, dose 2, dependent
MedDRA: Abnormal behaviour — Feeling: Good · Site: Pain, Itching · Headache, Nausea

Free text: Some behavior struggles

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Survey response — days 1–6 daily, dose 2, dependent
MedDRA: Decreased appetite — Feeling: Good · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Loss of appetite

MedDRA releases: 2024-11 · check-in free text available
2021-12-11
Health check-in — day 7, dose 2, dependent
Feeling: Good · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-18
Survey response — day 14, dose 2, dependent
MedDRA: Brain fog, Unevaluable event — Feeling: Fair · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Impulse control, mental fog

MedDRA releases: 2024-11 · check-in free text available
2021-12-18
Report sent to call center — day 14, dose 2, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-22
Call successful
Participant prefers to complete VAERS report online
2021-12-25
Health check-in — day 21, dose 2, dependent
Feeling: Good

Adult check-in
2022-01-01
Health check-in — day 28, dose 2, dependent
Feeling: Good

Adult check-in
2022-01-08
Health check-in — day 35, dose 2, dependent
Feeling: Good

Adult check-in
2022-01-15
Health check-in — day 42, dose 2, dependent
Feeling: Fair

Adult check-in
2022-03-05
Survey response — 3 months, dose 2, dependent
MedDRA: Cognitive disorder — Feeling: Fair · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Negative cognitive impacts

MedDRA releases: 2024-11 · check-in free text available
2022-03-05
Report sent to call center — 3 months, dose 2, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-03-09
Call 1 — Left Voicemail
2022-06-02
Dose 3 — Pfizer-BioNTech
2022-06-05
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Behaviour disorder, Brain fog — Feeling: Fair · Site: Itching · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Mental fog, behavioral challenges

MedDRA releases: 2024-11 · check-in free text available
2022-06-06
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Behaviour disorder, Brain fog — Feeling: Good · Site: Redness, Itching · Fatigue or tiredness

Free text: Behavioral challenges, mental fog

MedDRA releases: 2024-11 · check-in free text available
2022-06-07
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Behaviour disorder, Brain fog — Feeling: Fair · Site: Redness · Fatigue or tiredness

Free text: Mental fog and behavioral challenges

MedDRA releases: 2024-11 · check-in free text available
2022-06-08
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Brain fog — Feeling: Good · Fatigue or tiredness

Free text: Mental fog

MedDRA releases: 2024-11 · check-in free text available
2022-06-09
Survey response — day 7, dose 3, dependent
MedDRA: Behaviour disorder, Brain fog — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Mental fog, behavioral challenges

MedDRA releases: 2024-11 · check-in free text available
2022-06-18
Health check-in — day 14, dose 3, dependent
Feeling: Good

Adult check-in
2022-06-23
Survey response — day 21, dose 3, dependent
MedDRA: Behaviour disorder, Brain fog, Emotional disorder, Office visit — 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 · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Mental fog, behavioral challenges, emotion regulation degradation · Healthcare visit (other): In person mental health services

MedDRA releases: 2024-11 · check-in free text available
2022-06-23
Report sent to call center — day 21, 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-06-24
Call 1 — Left Voicemail
2022-06-30
Health check-in — day 28, dose 3, dependent
Feeling: Good

Adult check-in
2022-07-07
Health check-in — day 35, dose 3, dependent
Feeling: Good

Adult check-in
2022-07-19
Health check-in — day 42, dose 3, dependent
Feeling: Good

Adult check-in
2022-09-04
Survey response — 3 months, dose 3, dependent
MedDRA: Abdominal discomfort, Headache, Migraine, Office visit — 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

Free text: Symptoms: Frequent headaches/migraines with stomach upset · Healthcare visit (other): Primary care provider

MedDRA releases: 2024-11 · check-in free text available
2022-09-04
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 · 1 call case(s)
2022-09-06
Call 2 — Left Voicemail
2022-09-06
Call 2 — Left Voicemail
2022-09-06
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-11-11	Pfizer-BioNTech	No
2	2021-12-04	Pfizer-BioNTech	No
3	2022-06-02	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-12-03	Unsuccessful
2021-12-18	Successful 2021-12-22	Participant prefers to complete VAERS report online
2022-03-05	Unsuccessful
2022-06-23	Unsuccessful
2022-09-04	Unsuccessful

Free text

Release 10 — days 1–6 daily, dose 1, dependent

2021-11-14

Systemic reaction (other): Severe Mental fog

2021-11-15

Systemic reaction (other): Mental fogginess and difficulty remembering/following directions

Release 10 — day 7, dose 1, dependent

2021-11-18

Systemic reaction (other): Behavioral and cognitive shifts

Release 10 — day 14, dose 1, dependent

2021-11-25

Symptoms: Difficulty focusing and sitting still

Release 10 — day 21, dose 1, dependent

2021-12-03

Symptoms: Behavioral challenges, itchiness

Healthcare visit (other): PCP visit

Release 10 — days 1–6 daily, dose 2, dependent

2021-12-09

Systemic reaction (other): Some behavior struggles

2021-12-10

Systemic reaction (other): Loss of appetite

Release 10 — day 14, dose 2, dependent

2021-12-18

Symptoms: Impulse control, mental fog

Release 11 — 3 months, dose 2, dependent

2022-03-05

Symptoms: Negative cognitive impacts

Release 11 — days 1–6 daily, dose 3, dependent

2022-06-05

Systemic reaction (other): Mental fog, behavioral challenges

2022-06-06

Systemic reaction (other): Behavioral challenges, mental fog

2022-06-07

Systemic reaction (other): Mental fog and behavioral challenges

2022-06-08

Systemic reaction (other): Mental fog

Release 12 — day 7, dose 3, dependent

2022-06-09

Systemic reaction (other): Mental fog, behavioral challenges

Release 12 — day 21, dose 3, dependent

2022-06-23

Symptoms: Mental fog, behavioral challenges, emotion regulation degradation

Healthcare visit (other): In person mental health services

Release 12 — 3 months, dose 3, dependent

2022-09-04

Symptoms: Frequent headaches/migraines with stomach upset

Healthcare visit (other): Primary care provider

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	Abdominal discomfort	·	·	✓
SD	Behaviour disorder	·	·	✓
SD	Brain fog	·	·	✓
SD	Cognitive disorder	·	·	✓
SD	Disturbance in attention	·	·	✓
SD	Emotional disorder	·	·	✓
SD	Headache	·	·	✓
SD	Migraine	·	·	✓
SD	Pruritus	·	·	✓
SD	Restlessness	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Abnormal behaviour	·	·	✓
SRO	Behaviour disorder	·	·	✓
SRO	Brain fog	·	·	✓
SRO	Cognitive disorder	·	·	✓
SRO	Decreased appetite	·	·	✓
SRO	Memory impairment	·	·	✓

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