YU4-28601-67700
3 vaccinations
6 coded responses
25 check-ins
6 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 600 / IL
- Registered
- 2021-03-05
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-05
Registered in v-safe
-
2021-03-05
Dose 1 — Pfizer-BioNTech
- 2021-03-05
-
2021-03-06
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2021-03-07
- 2021-03-08
- 2021-03-09
-
2021-03-12
Health check-in — day 7, dose 1Feeling: Good · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-03-19
-
2021-03-26
Dose 2 — Pfizer-BioNTech
- 2021-03-26
- 2021-03-27
- 2021-03-28
- 2021-03-30
-
2021-06-28
Survey response — 3 months, dose 2MedDRA: Adverse drug reaction, Gastric ulcer, Gastrointestinal disorder, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activitiesFree text: Unrelated to COVID-19 or vaccinations for same, recently had an adverse stomach reaction/ulceration, likely related to an NSAID Rx for arthritic hand mobility and pain.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-09-24
-
2021-10-05
Dose 3 — Pfizer-BioNTech
-
2021-10-06
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Redness, Swelling · Fever · Muscle or body achesAdult check-in
- 2021-10-07
-
2021-10-08
Survey response — days 1–6 daily, dose 3MedDRA: Dizziness, Dyskinesia, Musculoskeletal stiffness — Feeling: Good · Headache, Muscle or body achesFree text: Light-headed/dizziness, seems associated with neck/muscle movement/stiffnessMedDRA releases: 2024-11 · check-in free text available
- 2021-10-09
- 2021-10-11
-
2021-10-13
Survey response — day 7, dose 3MedDRA: Dizziness — Feeling: Fair · Nausea, VomitingFree text: DizzinessMedDRA releases: 2024-11 · check-in free text available
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2021-10-19
Survey response — day 14, dose 3MedDRA: Abdominal pain upper, Computerised tomogram abnormal, Duodenitis, Helicobacter test positive, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Symptoms: Stomach pain and related. Conditions are most likely unrelated to Pfizer Vax booster. Just diagnosed by Cat scan as duodenitis and tested today for H-pylori as possible cause. · Healthcare visit (other): Follow up visit w/PCPMedDRA releases: 2024-11 · check-in free text available
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2021-10-19
Report sent to call center — day 14, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2021-10-22
- 2021-10-26
- 2021-11-04
-
2021-11-09
Survey response — day 35, dose 3MedDRA: Condition aggravated, Pre-existing disease — Feeling: FairFree text: My stomach issues, diagnosed as duodenitis, has flared up several times this past week and the complications of the H2/histamine release have occurred almost daily. None of this appears related to my Covid-19 Booster vaccination.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-18
-
2022-01-04
Survey response — 3 months, dose 3MedDRA: Back pain, Cough, Nasopharyngitis — Feeling: FairFree text: Persistent cough, occasional lower right back pain, and other cold symptomsMedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-05 | Pfizer-BioNTech | |
| 2 | 2021-03-26 | Pfizer-BioNTech | |
| 3 | 2021-10-05 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-10-19 | Unsuccessful |
Free text
Release 9 — 3 months, dose 2
Symptoms: Unrelated to COVID-19 or vaccinations for same, recently had an adverse stomach reaction/ulceration, likely related to an NSAID Rx for arthritic hand mobility and pain.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Light-headed/dizziness, seems associated with neck/muscle movement/stiffness
Release 10 — day 7, dose 3
Systemic reaction (other): Dizziness
Release 10 — day 14, dose 3
Symptoms: Stomach pain and related. Conditions are most likely unrelated to Pfizer Vax booster. Just diagnosed by Cat scan as duodenitis and tested today for H-pylori as possible cause.
Healthcare visit (other): Follow up visit w/PCP
Release 10 — day 35, dose 3
Symptoms: My stomach issues, diagnosed as duodenitis, has flared up several times this past week and the complications of the H2/histamine release have occurred almost daily. None of this appears related to my Covid-19 Booster vaccination.
Release 10 — 3 months, dose 3
Symptoms: Persistent cough, occasional lower right back pain, and other cold symptoms
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 pain upper | · | · | ✓ |
| SD | Adverse drug reaction | · | · | ✓ |
| SD | Back pain | · | · | ✓ |
| SD | Computerised tomogram abnormal | · | · | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Duodenitis | · | · | ✓ |
| SD | Gastric ulcer | · | · | ✓ |
| SD | Gastrointestinal disorder | ✓ | ✓ | ✓ |
| SD | Helicobacter test positive | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SRO | Dizziness | · | · | ✓ |
| SRO | Dyskinesia | · | · | ✓ |
| SRO | Musculoskeletal stiffness | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release