ZGB-29515-57962
1 vaccination
4 coded responses
15 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 117 / NY
- Registered
- 2021-03-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-03-03
Dose 1 — Pfizer-BioNTech
-
2021-03-04
Registered in v-safe
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2021-03-04
Survey response — days 1–6 daily, dose 1MedDRA: Anaphylactic shock, Anaphylaxis treatment, Emergency care, Lip swelling, Swollen tongue, Throat tightness — Feeling: Fair · Fatigue or tirednessFree text: Yes I went into anaphylactic shock after receiving the first dose. I was given an EpiPen and rushed to the hospital and IV was put in an additional medication was given to me by throat closed up my tongue and lips swelledMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-05
Survey response — days 1–6 daily, dose 1MedDRA: Anaphylactic shock, Dysphagia, Emergency care, Immediate post-injection reaction, Immunisation reaction, Lip swelling, Paraesthesia oral, Swollen tongue, Throat irritation, Throat tightness — Feeling: Good · HeadacheFree text: Yes on 3/22021 I was given the first Pfizer dose within 30 seconds I felt a wave if you come over me. After just a short few minutes my tongue began to swell my lips started to tingle in my throat got very scratchy and hard to swallow I was immediately given an EpiPen. Emt arrived and gave me a Benadryl shot. They try to get an IV in me but was unsuccessful the Benadryl shot it was done IM I was immediately taken to an ambulance and rushed to the hospital still during this time my throat was closing my tongue was swollen and my lips. I arrived at the emergency room they finally got an IV in me administered some steroids and several other medication I was closely watched in the ER for about 4 to 5 hours he told me I had an anaphylactic shock to the dose of the Pfizer one shot. I was advised that I cannot take another shot of the second visor due to the fact that I had that anaphylactic shock from the first Pfizer shot. I am very concerned now I will not be complete Protected from COVID-19MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-06
- 2021-03-07
- 2021-03-08
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2021-03-09
Survey response — days 1–6 daily, dose 1MedDRA: Oropharyngeal pain — Feeling: Fair · HeadacheFree text: Sore throatMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-10
Health check-in — day 7, dose 1Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-03-17
- 2021-03-24
- 2021-03-31
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2021-04-09
Survey response — day 35, dose 1MedDRA: Pneumonia — Feeling: Poor · 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: PneumoniaMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-09
Report sent to call center — day 35, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-14
- 2021-06-02
- 2021-09-01
- 2022-03-03
- 2022-03-22
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-03 | Pfizer-BioNTech |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-04-09 | Unsuccessful |
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Yes I went into anaphylactic shock after receiving the first dose. I was given an EpiPen and rushed to the hospital and IV was put in an additional medication was given to me by throat closed up my tongue and lips swelled
Systemic reaction (other): Yes on 3/22021 I was given the first Pfizer dose within 30 seconds I felt a wave if you come over me. After just a short few minutes my tongue began to swell my lips started to tingle in my throat got very scratchy and hard to swallow I was immediately given an EpiPen. Emt arrived and gave me a Benadryl shot. They try to get an IV in me but was unsuccessful the Benadryl shot it was done IM I was immediately taken to an ambulance and rushed to the hospital still during this time my throat was closing my tongue was swollen and my lips. I arrived at the emergency room they finally got an IV in me administered some steroids and several other medication I was closely watched in the ER for about 4 to 5 hours he told me I had an anaphylactic shock to the dose of the Pfizer one shot. I was advised that I cannot take another shot of the second visor due to the fact that I had that anaphylactic shock from the first Pfizer shot. I am very concerned now I will not be complete Protected from COVID-19
Systemic reaction (other): Sore throat
Release 7 — day 35, dose 1
Symptoms: Pneumonia
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 | Pneumonia | ✓ | ✓ | ✓ |
| SRO | Anaphylactic shock | ✓ | ✓ | ✓ |
| SRO | Anaphylaxis treatment | ✓ | ✓ | ✓ |
| SRO | Dysphagia | ✓ | ✓ | ✓ |
| SRO | Emergency care | ✓ | ✓ | ✓ |
| SRO | Immediate post-injection reaction | ✓ | ✓ | ✓ |
| SRO | Immunisation reaction | ✓ | ✓ | ✓ |
| SRO | Lip swelling | ✓ | ✓ | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SRO | Paraesthesia oral | ✓ | ✓ | ✓ |
| SRO | Swollen tongue | ✓ | ✓ | ✓ |
| SRO | Throat irritation | ✓ | ✓ | ✓ |
| SRO | Throat tightness | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release