Y4P-28496-17645
4 vaccinations
7 coded responses
47 check-ins
7 free-text entries
4 call cases
- Sex
- Female
- Age at first dose
- 05-11
- ZIP prefix
- 481 / MI
- Registered
- 2021-11-05
- Relationship
- Child or adolescent in my care
- Guardian
- QHX-32840-96294
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-11-05
Registered in v-safe
-
2021-11-06
Dose 1 — Pfizer-BioNTech
- 2021-11-06
-
2021-11-07
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-11-08
- 2021-11-09
- 2021-11-11
- 2021-11-12
- 2021-11-13
- 2021-11-20
- 2021-11-27
-
2021-11-30
Dose 2 — Pfizer-BioNTech
-
2021-12-02
Health check-in — days 1–6 daily, dose 2, dependentFeeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-12-03
- 2021-12-04
- 2021-12-05
- 2021-12-06
- 2021-12-07
- 2021-12-14
- 2021-12-21
- 2021-12-28
- 2022-01-04
-
2022-01-11
Survey response — day 42, dose 2, dependentMedDRA: Rash — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: A rash on the toes getting increasingly more bothersomeMedDRA releases: 2024-11 · check-in free text available
-
2022-01-11
Report sent to call center — day 42, dose 2, dependentGet care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-01-12
-
2022-01-12
Call successfulDoes not wish to fill out VAERS report
- 2022-03-01
-
2022-05-21
Dose 3 — Pfizer-BioNTech
-
2022-05-21
Health check-in — day 0, dose 3, dependentFeeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2022-05-22
- 2022-05-23
- 2022-05-24
- 2022-05-26
- 2022-05-27
- 2022-05-28
- 2022-06-04
- 2022-06-11
- 2022-06-18
- 2022-06-25
- 2022-07-02
- 2022-08-20
-
2022-11-05
Dose 4 — Moderna
- 2022-11-05
-
2022-11-06
Health check-in — days 1–6 daily, dose 4, dependentFeeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-11-07
Survey response — days 1–6 daily, dose 4, dependentMedDRA: Illness — Feeling: Poor · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: (b)(6) has an illness unrelated to vaccineMedDRA releases: 2024-11 · check-in free text available
-
2022-11-08
Survey response — days 1–6 daily, dose 4, dependentMedDRA: Respiratory disorder — Feeling: Poor · Fever · Chills, Fatigue or tiredness · Be unable to work or attend schoolFree text: Diagnosed with a non Covid respiratory illnessMedDRA releases: 2024-11 · check-in free text available
-
2022-11-09
Survey response — days 1–6 daily, dose 4, dependentMedDRA: Illness — Feeling: Poor · Fever · Chills, Headache, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: (b)(6) had a non-Covid illnessMedDRA releases: 2024-11 · check-in free text available
-
2022-11-10
Survey response — days 1–6 daily, dose 4, dependentMedDRA: Illness — Feeling: Poor · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Has a non Covid illnessMedDRA releases: 2024-11 · check-in free text available
-
2022-11-10
Report sent to call center — days 1–6 daily, dose 4, dependentBe unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-11-11
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-11-19
- 2022-11-26
-
2022-12-03
Survey response — day 28, dose 4, dependentMedDRA: SARS-CoV-2 test negative — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Very swollen lymph nodes not accompanied by an obvious illness. Not Covid, not strep.MedDRA releases: 2024-11 · check-in free text available
-
2022-12-03
Report sent to call center — day 28, dose 4, dependentBe unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-12-05
Call successfulParticipant prefers to complete VAERS report online
- 2022-12-10
-
2022-12-19
Survey response — day 42, dose 4, dependentMedDRA: Lymphadenopathy, Upper respiratory tract infection — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: She continues to have swollen lymph nodes and repeated upper respiratory infections (not Covid).MedDRA releases: 2024-11 · check-in free text available
-
2022-12-19
Report sent to call center — day 42, dose 4, dependentGet care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-12-20
- 2023-02-04
- 2023-05-07
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-11-06 | Pfizer-BioNTech | No |
| 2 | 2021-11-30 | Pfizer-BioNTech | No |
| 3 | 2022-05-21 | Pfizer-BioNTech | No |
| 4 | 2022-11-05 | Moderna | No |
Call center
4 call center cases
3 successful · 1 unsuccessful
Free text
Release 10 — day 42, dose 2, dependent
Symptoms: A rash on the toes getting increasingly more bothersome
Release 12 — days 1–6 daily, dose 4, dependent
Systemic reaction (other): Diagnosed with a non Covid respiratory illness
Systemic reaction (other): Has a non Covid illness
Release 12 — day 28, dose 4, dependent
Symptoms: Very swollen lymph nodes not accompanied by an obvious illness. Not Covid, not strep.
Release 12 — day 42, dose 4, dependent
Symptoms: She continues to have swollen lymph nodes and repeated upper respiratory infections (not Covid).
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 | Lymphadenopathy | · | · | ✓ |
| SD | Rash | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Upper respiratory tract infection | · | · | ✓ |
| SRO | Illness | · | · | ✓ |
| SRO | Respiratory disorder | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release