Y77-21203-83072
4 vaccinations
15 coded responses
56 check-ins
14 free-text entries
8 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 019 / MA
- Registered
- 2021-03-18
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-17
Dose 1 — Janssen/Johnson & Johnson
-
2021-03-18
Registered in v-safe
-
2021-03-18
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Redness · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-03-19
Survey response — days 1–6 daily, dose 1MedDRA: Sleep disorder — Feeling: GoodFree text: Sleep disruptionMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-20
Survey response — days 1–6 daily, dose 1MedDRA: Sleep disorder, Tinnitus — Feeling: GoodFree text: Disruptive sleep due to ringing in the ears since the day of receiving the vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-21
Survey response — days 1–6 daily, dose 1MedDRA: Insomnia, Tinnitus — Feeling: GoodFree text: Ear ringing had diminished. Finally got a good nights sleepMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-22
Survey response — days 1–6 daily, dose 1MedDRA: Tinnitus — Feeling: GoodFree text: Ringing in the ear...seeing my PCP on Wed.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-23
Survey response — days 1–6 daily, dose 1MedDRA: Tinnitus — Feeling: GoodFree text: Ears ringingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-24
Survey response — day 7, dose 1MedDRA: Middle ear effusion, Office visit, Tinnitus — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Systemic reaction (other): Ringing in ear.... saw nurse practitioner today. Going for a hearing test. Also told me to start antihistamines. Possibly caused by fluid behind the ear or pollen allergies. · Healthcare visit (other): PCP office with nurse practitionerMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-24
Report sent to call center — day 7, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-03-26
-
2021-03-31
Survey response — day 14, dose 1MedDRA: Office visit, Tinnitus — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Constant ringing in the right ear. Saw my PCP... he could do nothing about it. Going for a hearing test on4/5/21 · Healthcare visit (other): In office visit with my PCPMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-31
Report sent to call center — day 14, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-06
-
2021-04-07
Survey response — day 21, single doseMedDRA: Office visit, Tinnitus — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Tinnitus in right ear since receiving the vaccine. Saw my PCP... referred to EENT doctor.... referred for a hearing test. All found no cause they could pinpoint. Given info on how to live with tinnitus. How about info on how to SLEEP with it??? · Healthcare visit (other): Doctor office visitsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-07
Report sent to call center — day 21, single doseGet care from a doctor or other healthcare professional1 call case(s)
- 2021-04-08
-
2021-04-08
Call successfulCompleted over the phone
-
2021-04-08
Call successfulCompleted over the phone
-
2021-04-08
Call successfulCompleted over the phone
-
2021-04-14
Survey response — day 28, single doseMedDRA: Office visit, Tinnitus — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Ringing in the ears continues 24/7. I filed a formal report to VAERS on the condition. No improvement since 3/17/21. · Healthcare visit (other): Office visit with PCP, Eye ear nose and throat doctor and a hearing testMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-14
Report sent to call center — day 28, single doseGet care from a doctor or other healthcare professional1 call case(s)
-
2021-04-20
Call successfulReported to VAERS during previous contact from GDIT
- 2021-04-21
-
2021-04-28
Survey response — day 42, single doseMedDRA: Rash erythematous — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Have developed red blotches on my back neck legs and armsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-28
Report sent to call center — day 42, single doseGet care from a doctor or other healthcare professional1 call case(s)
- 2021-05-06
- 2021-06-16
-
2021-09-15
Survey response — 6 months, dose 1MedDRA: Biopsy skin abnormal, Drug eruption, Office visit, Rash — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Body rash 10 weeks after vaccine. Dermatologist determined by biopsy of two blotches that it was a medication induced rash · Healthcare visit (other): Dermatologist appointment as follow up to urgent careMedDRA releases: 2024-11 · check-in free text available
-
2021-09-15
Report sent to call center — 6 months, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-16
-
2021-11-09
Dose 2 — Pfizer-BioNTech
-
2021-11-11
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
-
2021-11-12
Survey response — days 1–6 daily, dose 2MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
- 2021-11-13
- 2021-11-14
- 2021-11-15
- 2021-11-16
- 2021-11-23
- 2021-11-30
- 2021-12-07
- 2021-12-14
- 2021-12-21
- 2022-02-08
-
2022-02-24
Dose 3 — Pfizer-BioNTech
- 2022-02-24
- 2022-02-25
- 2022-02-26
- 2022-02-27
- 2022-02-28
- 2022-03-01
- 2022-03-02
- 2022-03-03
- 2022-03-10
- 2022-03-17
- 2022-03-24
- 2022-04-02
- 2022-04-07
- 2022-05-26
- 2022-08-25
-
2022-10-11
Dose 4 — Pfizer-BioNTech
- 2022-10-11
- 2022-10-12
-
2022-10-13
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
- 2022-10-14
- 2022-10-15
- 2022-10-16
- 2022-10-17
- 2022-10-18
-
2022-10-25
Survey response — day 14, dose 4MedDRA: Cough, Headache, Influenza virus test negative, Oropharyngeal pain, SARS-CoV-2 test negative, Sinus pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Headaches, sore throat and sinus pain and a dry cough · Healthcare visit (other): Tested for Covid, Flu and strep throat. All tests were negative.MedDRA releases: 2024-11 · check-in free text available
-
2022-10-25
Report sent to call center — day 14, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-10-26
Call successfulReported to VAERS during previous contact from GDIT
-
2022-10-26
Call successfulReported to VAERS during previous contact from GDIT
-
2022-10-26
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-11-01
- 2022-11-08
- 2022-11-15
- 2022-11-22
-
2023-01-10
Survey response — 3 months, dose 4MedDRA: Cough, Headache, Pain, Pyrexia, Respiratory tract congestion — Feeling: Fair · 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
-
2023-01-10
Report sent to call center — 3 months, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2023-01-11
Call successfulNot applicable - Accidental Reporting
- 2023-04-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-17 | Janssen/Johnson & Johnson | |
| 2 | 2021-11-09 | Pfizer-BioNTech | No |
| 3 | 2022-02-24 | Pfizer-BioNTech | No |
| 4 | 2022-10-11 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-03-24 | Successful 2021-04-08 |
Completed over the phone |
| 2021-03-31 | Successful 2021-04-08 |
Completed over the phone |
| 2021-04-07 | Successful 2021-04-08 |
Completed over the phone |
| 2021-04-14 | Successful 2021-04-20 |
Reported to VAERS during previous contact from GDIT |
| 2021-04-28 | Successful 2022-10-26 |
Reported to VAERS during previous contact from GDIT |
| 2021-09-15 | Successful 2022-10-26 |
Reported to VAERS during previous contact from GDIT |
| 2022-10-25 | Successful 2022-10-26 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2023-01-10 | Successful 2023-01-11 |
Not applicable - Accidental Reporting |
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Sleep disruption
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): Disruptive sleep due to ringing in the ears since the day of receiving the vaccine
Systemic reaction (other): Ear ringing had diminished. Finally got a good nights sleep
Systemic reaction (other): Ringing in the ear...seeing my PCP on Wed.
Systemic reaction (other): Ears ringing
Release 6 — day 7, dose 1
Systemic reaction (other): Ringing in ear.... saw nurse practitioner today. Going for a hearing test. Also told me to start antihistamines. Possibly caused by fluid behind the ear or pollen allergies.
Healthcare visit (other): PCP office with nurse practitioner
Release 6 — day 14, dose 1
Symptoms: Constant ringing in the right ear. Saw my PCP... he could do nothing about it. Going for a hearing test on4/5/21
Healthcare visit (other): In office visit with my PCP
Release 7 — day 21, single dose
Symptoms: Tinnitus in right ear since receiving the vaccine. Saw my PCP... referred to EENT doctor.... referred for a hearing test. All found no cause they could pinpoint. Given info on how to live with tinnitus. How about info on how to SLEEP with it???
Healthcare visit (other): Doctor office visits
Release 7 — day 28, single dose
Symptoms: Ringing in the ears continues 24/7. I filed a formal report to VAERS on the condition. No improvement since 3/17/21.
Healthcare visit (other): Office visit with PCP, Eye ear nose and throat doctor and a hearing test
Release 8 — day 42, single dose
Symptoms: Have developed red blotches on my back neck legs and arms
Release 9 — 6 months, dose 1
Symptoms: Body rash 10 weeks after vaccine. Dermatologist determined by biopsy of two blotches that it was a medication induced rash
Healthcare visit (other): Dermatologist appointment as follow up to urgent care
Release 10 — days 1–6 daily, dose 2
Systemic reaction (other): No
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): No
Release 12 — day 14, dose 4
Symptoms: Headaches, sore throat and sinus pain and a dry cough
Healthcare visit (other): Tested for Covid, Flu and strep throat. All tests were negative.
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 | Influenza virus test negative | · | · | ✓ |
| HCVO | Office visit | ✓ | ✓ | ✓ |
| HCVO | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Biopsy skin abnormal | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Drug eruption | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Office visit | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Rash | · | · | ✓ |
| SD | Rash erythematous | ✓ | ✓ | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Sinus pain | · | · | ✓ |
| SD | Tinnitus | ✓ | ✓ | ✓ |
| SRO | Insomnia | ✓ | ✓ | ✓ |
| SRO | Middle ear effusion | ✓ | ✓ | ✓ |
| SRO | No adverse event | · | · | ✓ |
| SRO | Office visit | ✓ | ✓ | ✓ |
| SRO | Sleep disorder | ✓ | ✓ | ✓ |
| SRO | Tinnitus | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release