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ZRG-77004-90476

4 vaccinations 3 coded responses 10 check-ins 3 free-text entries 1 call case
Sex
Male
Age at first dose
41-45
ZIP prefix
922 / CA
Registered
2021-12-12
Relationship
Self
Race
N/A
Ethnicity
Hispanic or Latino
Registered dependents
MBN-87301-65190 Child or adolescent in my care · Male · 2021-12-12

Timeline

  1. 2021-03-26
    Dose 1 — Pfizer-BioNTech
  2. 2021-04-16
    Dose 2 — Pfizer-BioNTech
  3. 2021-12-08
    Dose 3 — Moderna
    Co-administered: Flu
  4. 2021-12-12
    Registered in v-safe
  5. 2021-12-14
    Survey response — days 1–6 daily, dose 3
    MedDRA: Nasopharyngitis, SARS-CoV-2 test negative — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities
    Free text: Seems I have a common cold. I received a COVID rapid test yesterday and was negative.
    MedDRA releases: 2024-11 · check-in free text available
  6. 2021-12-15
    Survey response — day 7, dose 3
    MedDRA: Nasal congestion, Nasopharyngitis, Oropharyngeal pain, Respiratory tract congestion, Unevaluable event — Feeling: Poor · Fatigue or tiredness · Get care from a doctor or other healthcare professional
    Free text: Systemic reaction (other): Severe sore throat, chest and nasal congestion, seems like a severe cold. · Healthcare visit (other): I cancelled a dentist appointment to have a crown replaced.
    MedDRA releases: 2024-11 · check-in free text available
  7. 2021-12-15
    Report sent to call center — day 7, dose 3
    Get care from a doctor or other healthcare professional
    1 call case(s)
  8. 2021-12-16
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  9. 2021-12-24
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  10. 2021-12-29
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  11. 2022-01-06
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  12. 2022-01-19
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  13. 2022-03-09
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  14. 2022-06-08
    Survey response — 6 months, dose 3
    MedDRA: Headache, Nasal congestion, Oropharyngeal pain, Rhinorrhoea, Self-medication — Feeling: Fair
    Free text: Over the past week, I had a headache, soar throat and stuffy/runny nose. The symptoms are subsiding now but were pretty bad. I didn't stop working or any activities because I am taking prescription methylphenidate and Advil to help with symptoms.
    MedDRA releases: 2024-11 · check-in free text available
  15. 2022-10-18
    Dose 4 — Pfizer-BioNTech
    Co-administered: Flu
  16. 2022-12-08
    Health check-in — 12 months, dose 3
    Feeling: Good
    Adult check-in
  17. 2023-01-17
    Health check-in — 3 months, dose 4
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-03-26Pfizer-BioNTech No
22021-04-16Pfizer-BioNTech No
32021-12-08Moderna Flu
42022-10-18Pfizer-BioNTech Flu

Call center

ReportedOutcomeVAERS-related outcome
2021-12-15 Successful
2021-12-16
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 10 — days 1–6 daily, dose 3

2021-12-14

Systemic reaction (other): Seems I have a common cold. I received a COVID rapid test yesterday and was negative.

Release 10 — day 7, dose 3

2021-12-15

Systemic reaction (other): Severe sore throat, chest and nasal congestion, seems like a severe cold.
Healthcare visit (other): I cancelled a dentist appointment to have a crown replaced.

Release 11 — 6 months, dose 3

2022-06-08

Symptoms: Over the past week, I had a headache, soar throat and stuffy/runny nose. The symptoms are subsiding now but were pretty bad. I didn't stop working or any activities because I am taking prescription methylphenidate and Advil to help with 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

FieldPreferred term2021-092023-042024-11
HCVOUnevaluable event · · ✓
SDHeadache · · ✓
SDNasal congestion · · ✓
SDOropharyngeal pain · · ✓
SDRhinorrhoea · · ✓
SDSelf-medication · · ✓
SRONasal congestion · · ✓
SRONasopharyngitis · · ✓
SROOropharyngeal pain · · ✓
SRORespiratory tract congestion · · ✓
SROSARS-CoV-2 test negative · · ✓

✓ active code · ○ coded but marked inactive · blank = not in that release