YA9-29309-08358
3 vaccinations
7 coded responses
18 check-ins
7 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 56-60
- ZIP prefix
- 113 / NY
- Registered
- 2021-03-08
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Registered dependents
QTC-13455-85231
Child or adolescent in my care · Female · 2022-06-24
Timeline
-
2021-03-08
Registered in v-safe
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2021-03-08
Dose 1 — Janssen/Johnson & Johnson
-
2021-03-08
Survey response — day 0, dose 1MedDRA: Nasal pruritus — Feeling: GoodFree text: Itching inside the nose and chasper in the throat. Thats it.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-09
Survey response — days 1–6 daily, dose 1MedDRA: Flank pain — Feeling: Good · Site: Pain · Headache, Muscle or body aches, DiarrheaFree text: Pain in my waistMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-10
-
2021-03-11
Survey response — days 1–6 daily, dose 1MedDRA: Ear pain, Headache, Pain — Feeling: Fair · Site: Pain · HeadacheFree text: I have never had pain in my left ear, I have now it is not constant but it is like a nail pinch, the same thing with headache, my left side is never in pain now it is also with pinch like painMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-12
- 2021-03-13
-
2021-03-14
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Nausea, Diarrhea · Be unable to do your normal daily activitiesAdult check-in
- 2021-03-15
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2021-03-22
Survey response — day 14, dose 1MedDRA: Diarrhoea — Feeling: FairFree text: DiarrheaMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-29
Survey response — day 21, single doseMedDRA: Pruritus, Rash — Feeling: FairFree text: Rash itching in the arm where I had the vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-05
- 2021-04-12
-
2021-04-19
Survey response — day 42, single doseMedDRA: Diarrhoea — Feeling: Poor · Be unable to do your normal daily activitiesFree text: This is my 5th week with diarrhea, no medicine is helping even prescribed medicine. I dont know what to do. I have no insurance.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-06-07
- 2021-09-06
-
2022-01-07
Dose 2 — Pfizer-BioNTech
-
2022-06-06
Dose 3 — Pfizer-BioNTech
- 2022-06-24
- 2022-06-27
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2022-09-07
Survey response — 3 months, dose 3MedDRA: Back pain, Cough, Malaise, Nasopharyngitis, Pre-existing disease, SARS-CoV-2 test negative — 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 visitFree text: I had cold like symptoms , I tested negative for covid-19 twice? I have been sick already for more than a month, coughing, back pain and allergies, still not over.MedDRA releases: 2024-11 · check-in free text available
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2022-09-07
Report sent to call center — 3 months, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-09-08
-
2022-09-08
Callback requested for11:30AM ET
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-08 | Janssen/Johnson & Johnson | |
| 2 | 2022-01-07 | Pfizer-BioNTech | No |
| 3 | 2022-06-06 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-09-07 | Unsuccessful |
Free text
Release 5 — day 0, dose 1
Systemic reaction (other): Itching inside the nose and chasper in the throat. Thats it.
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Pain in my waist
Systemic reaction (other): I have never had pain in my left ear, I have now it is not constant but it is like a nail pinch, the same thing with headache, my left side is never in pain now it is also with pinch like pain
Release 6 — day 14, dose 1
Symptoms: Diarrhea
Release 6 — day 21, single dose
Symptoms: Rash itching in the arm where I had the vaccine
Release 7 — day 42, single dose
Symptoms: This is my 5th week with diarrhea, no medicine is helping even prescribed medicine. I dont know what to do. I have no insurance.
Release 12 — 3 months, dose 3
Symptoms: I had cold like symptoms , I tested negative for covid-19 twice? I have been sick already for more than a month, coughing, back pain and allergies, still not over.
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 | Back pain | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Diarrhoea | ✓ | ✓ | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Pruritus | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Ear pain | ✓ | ✓ | ✓ |
| SRO | Flank pain | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Nasal pruritus | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release