Y5T-21541-10119
4 vaccinations
6 coded responses
47 check-ins
6 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 837 / ID
- Registered
- 2021-02-05
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-04
Dose 1 — Pfizer-BioNTech
-
2021-02-05
Registered in v-safe
- 2021-02-05
- 2021-02-06
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-11
- 2021-02-18
-
2021-02-25
Dose 2 — Pfizer-BioNTech
- 2021-02-25
- 2021-02-26
- 2021-02-27
- 2021-02-28
-
2021-03-01
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Fever · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-11
- 2021-03-18
-
2021-03-25
Survey response — day 28, dose 2MedDRA: Abdominal discomfort, Asthenia — Feeling: FairFree text: Lack of energy and gastric upset.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-01
- 2021-04-10
-
2021-05-28
Survey response — 3 months, dose 2MedDRA: Deafness unilateral, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Sudden hearing loss in left ear. · Healthcare visit (other): Visit with ear specialist (MD). MRI which turned out normal.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-28
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2021-08-17
Dose 3 — Pfizer-BioNTech
- 2021-08-18
- 2021-08-19
- 2021-08-20
-
2021-08-21
Survey response — days 1–6 daily, dose 3MedDRA: Food poisoning — Feeling: Good · Nausea, Vomiting, DiarrheaFree text: May be caused by food poisoning.MedDRA releases: 2021-09,2024-11 · check-in free text available
- 2021-08-22
- 2021-08-24
- 2021-08-31
-
2021-09-07
Survey response — day 21, dose 3MedDRA: Asthenia, Pyrexia — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Fever and weakness. No problems breathing. These issues occurred 17 days after my shot and lasted 5 days. I am not sure they are related to the booster shot.MedDRA releases: 2024-11 · check-in free text available
- 2021-09-14
- 2021-09-21
- 2021-09-28
-
2021-11-18
Survey response — 3 months, dose 3MedDRA: Appendicitis perforated, Surgery — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Burst appendix surgery 11/19/2021MedDRA releases: 2024-11 · check-in free text available
-
2021-11-18
Report sent to call center — 3 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2021-11-19
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-02-15
-
2022-04-16
Dose 4 — Pfizer-BioNTech
- 2022-04-18
- 2022-04-19
- 2022-04-20
- 2022-04-21
- 2022-04-22
- 2022-04-23
- 2022-04-30
- 2022-05-07
- 2022-05-14
- 2022-05-21
- 2022-05-28
-
2022-07-16
Survey response — 3 months, dose 4MedDRA: Cough, Fatigue, Office visit, SARS-CoV-2 test positive — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Fatigue and cough. Positive COVID test at clinic.MedDRA releases: 2024-11 · check-in free text available
- 2022-10-15
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-04 | Pfizer-BioNTech | |
| 2 | 2021-02-25 | Pfizer-BioNTech | |
| 3 | 2021-08-17 | Pfizer-BioNTech | No |
| 4 | 2022-04-16 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-05-28 | Successful | Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2021-11-18 | Successful 2021-11-19 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 6 — day 28, dose 2
Symptoms: Lack of energy and gastric upset.
Release 8 — 3 months, dose 2
Symptoms: Sudden hearing loss in left ear.
Healthcare visit (other): Visit with ear specialist (MD). MRI which turned out normal.
Release 9 — days 1–6 daily, dose 3
Systemic reaction (other): May be caused by food poisoning.
Release 9 — day 21, dose 3
Symptoms: Fever and weakness. No problems breathing. These issues occurred 17 days after my shot and lasted 5 days. I am not sure they are related to the booster shot.
Release 10 — 3 months, dose 3
Symptoms: Burst appendix surgery 11/19/2021
Release 12 — 3 months, dose 4
Symptoms: Fatigue and cough. Positive COVID test at clinic.
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 | Appendicitis perforated | · | · | ✓ |
| SD | Asthenia | ✓ | ✓ | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Deafness unilateral | ✓ | ✓ | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Surgery | · | · | ✓ |
| SRO | Food poisoning | ✓ | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release