Document text
Listing 7.7.5 Page 1of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 289of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1000222784 28/F/WHITE FIRST DOSE 2020 -12-30Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-20Pfizer 2021 -01-21 UNKNOWN Left arm
2021 -01-21Pfizer UNKNOWN Left arm
C4591008 -1003079744 34/M/WHITE FIRST DOSE 1986 -06-24Pfizer 2020 -12-20 EJ1685 Right arm
2020 -12-20Pfizer EJ1685 Right arm
SECOND DOSE 2021 -01-10Pfizer UNKNOWN Right arm
C4591008 -1003225152 34/F/WHITE FIRST DOSE 2021 -01-08Moderna 026L20A Right arm
SECOND DOSE 2021 -02-05Moderna 029L20A Right arm
C4591008 -1006879296 45/M/WHITE FIRST DOSE 2020 -12-30Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-19Pfizer 20210119F
EL0140Right arm
C4591008 -1008207936 65/M/WHITE FIRST DOSE 2020 -12-18Pfizer eh9899 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073740
Listing 7.7.5 Page 2of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 290of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-07Pfizer EL1283 Left arm
C4591008 -1010945600 46/M/WHITE FIRST DOSE 2020 -12-24Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-10Pfizer EL1283 Left arm
UNKNOWN Left arm
C4591008 -1011888704 59/F/WHITE FIRST DOSE 2021 -01-11Pfizer EL0140 Left arm
SECOND DOSE 2021 -02-02Pfizer EL3246 Left arm
C4591008 -1012101184 57/F/WHITE FIRST DOSE 2020 -12-30Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-20Pfizer EL3302 Left arm
C4591008 -1013775424 65/F/WHITE FIRST DOSE 2021 -01-09Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-27Pfizer UNKNOWN Left arm
C4591008 -1014345792 75/M/WHITE FIRST DOSE 2020 -12-22Pfizer EK5730 Left arm
EKS730 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073741
Listing 7.7.5 Page 3of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 291of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-12Pfizer EK9231 Left arm
C4591008 -1015169600 31/F/WHITE FIRST DOSE 2020 -12-30Moderna 025L20A Left arm
SECOND DOSE 2021 -01-27Moderna 030L20A Left arm
C4591008 -1015887936 47/F/WHITE FIRST DOSE 2020 -12-21Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-21Pfizer UNKNOWN Arm (side
unknown)
C4591008 -1017534528 49/M/WHITE FIRST DOSE 2020 -12-21Pfizer eh9899 Right arm
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Right arm
C4591008 -1018226752 60// FIRST DOSE 2020 -12-23Pfizer UNKNOWN Left arm
C4591008 -1018784832 40/F/WHITE FIRST DOSE 2020 -12-26Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-15Pfizer UNKNOWN Right arm
C4591008 -1019913792 53/M/WHITE FIRST DOSE 2021 -01-13Moderna UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073742
Listing 7.7.5 Page 4of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 292of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-10Moderna 029l20a Right arm
C4591008 -1020870720 50/F/WHITE FIRST DOSE 2020 -12-28Pfizer EL1284 Left arm
SECOND DOSE 2021 -01-18Pfizer EJ1686 Right arm
C4591008 -1022384704 55/F/WHITE FIRST DOSE 2021 -01-10Pfizer EL 3246 Left arm
SECOND DOSE 2021 -01-31Pfizer EL9262 Right arm
C4591008 -1022543936 43//
C4591008 -1023421504 34/F/MULTIPL
EFIRST DOSE 2021 -01-08Pfizer EL0142 Right arm
SECOND DOSE 2021 -01-29Pfizer UNKNOWN Left arm
C4591008 -1023819328 26/F/WHITE FIRST DOSE 2021 -01-03Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-28Pfizer EN9581 Left arm
C4591008 -1025268288 35/M/WHITE FIRST DOSE 2020 -12-28Pfizer EL0KL0 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073743
Listing 7.7.5 Page 5of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 293of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2020 -01-18Pfizer ELO140 Left arm
C4591008 -1026529856 31/F/WHITE FIRST DOSE 2021 -01-06Moderna 012L20A Left arm
SECOND DOSE 2021 -02-04Moderna 004M20A Right arm
C4591008 -1026995264 37//
C4591008 -1027938368 33/F/WHITE FIRST DOSE 2021 -01-15Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-12Moderna UNKNOWN Right arm
C4591008 -1031008320 28/F/WHITE FIRST DOSE 2021 -01-04Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-25Pfizer EL9262 Left arm
C4591008 -1031725632 57// FIRST DOSE 2020 -12-18Pfizer UNKNOWN Left arm
C4591008 -1032362560 35/F/WHITE FIRST DOSE 2020 -12-16Pfizer EH9899 Right arm
SECOND DOSE 2021 -01-06Pfizer EH9899 Left arm
C4591008 -1033372736 30//
C4591008 -1034833984 32/F/WHITE FIRST DOSE 2020 -12-30Pfizer EK9231 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073744
Listing 7.7.5 Page 6of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 294of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-17Pfizer EL3247 Left arm
UNKNOWN Left arm
C4591008 -1036109376 51/F/NOT
REPORTEDFIRST DOSE 2020 -12-21Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -02-14Pfizer UNKNOWN Right arm
C4591008 -1036349504 36/F/WHITE FIRST DOSE 2020 -12-18Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -1037756992 42// SECOND DOSE 2021 -01-20Pfizer EL3247 Left arm
C4591008 -1038954048 46/M/ASIAN FIRST DOSE 2020 -12-16Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-06Pfizer UNKNOWN Left arm
C4591008 -1040269376 62/F/WHITE FIRST DOSE 2021 -01-06Moderna 027L20A Left arm
SECOND DOSE 2021 -02-03Moderna 015M20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073745
Listing 7.7.5 Page 7of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 295of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1040587840 46/F/WHITE FIRST DOSE 2021 -01-22Pfizer EL1283 Left arm
SECOND DOSE 2021 -02-12Pfizer UNKNOWN Left arm
C4591008 -1040972352 36//
C4591008 -1041132096 41/F/WHITE FIRST DOSE 2020 -12-23Moderna 037K20A Left arm
SECOND DOSE 2021 -01-22Moderna 032L20A Left arm
C4591008 -1043245632 33/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -02-04Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-25Pfizer UNKNOWN Left arm
C4591008 -1044301376 31/F/MULTIPL
EFIRST DOSE 2021 -03-05Pfizer EN6206 Left arm
SECOND DOSE 2021 -03-28Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073746
Listing 7.7.5 Page 8of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 296of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1044785728 37/F/WHITE FIRST DOSE 2020 -12-22Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-11Pfizer EL3248 Left arm
C4591008 -1045237312 42// FIRST DOSE 2020 -12-28Pfizer EL1284 Left arm
C4591008 -1045264448 50/F/WHITE FIRST DOSE 2020 -12-22Pfizer EH9899 Right arm
SECOND DOSE 2021 -01-14Pfizer UNKNOWN Right arm
C4591008 -1047709760 62/F/WHITE FIRST DOSE 2020 -12-21Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-11Pfizer EJ1686 Right arm
C4591008 -1048254528 26/F/WHITE FIRST DOSE 2020 -12-17Pfizer EH9899 Left arm
C4591008 -1049954880 54/M/WHITE FIRST DOSE 2020 -12-22Pfizer EJ1685 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073747
Listing 7.7.5 Page 9of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 297of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-12Pfizer EL 1283 Left arm
C4591008 -1050685504 50/F/WHITE FIRST DOSE 2021 -01-14Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-04Pfizer UNKNOWN Left arm
C4591008 -1052007488 39//
C4591008 -1052665408 41//
C4591008 -1053740608 65/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -1054591552 33/F/WHITE FIRST DOSE 2020 -12-21Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-07Pfizer EL1283 Left arm
C4591008 -1055097408 54/M/WHITE FIRST DOSE 2021 -01-05Pfizer EJ1685 Right arm
SECOND DOSE 2021 -01-27Pfizer EL3249 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073748
Listing 7.7.5 Page 10of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 298of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1057223232 28/F/WHITE FIRST DOSE 2021 -01-13Moderna 039K20A Left arm
SECOND DOSE 2021 -02-11Moderna 028L20A Left arm
C4591008 -1059175488 35/F/WHITE FIRST DOSE 2020 -12-18Pfizer EJ1685 Right arm
SECOND DOSE 2021 -02-03Pfizer EL9261 Left arm
C4591008 -1060278336 50/F/WHITE FIRST DOSE 2020 -12-24Moderna 037K20A Left arm
SECOND DOSE 2021 -01-20Moderna 025L20A Left arm
C4591008 -1060438592 28//
C4591008 -1060691008 41/F/WHITE FIRST DOSE 2020 -12-17Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-07Pfizer EL1284 Left arm
C4591008 -1062537280 61/F/WHITE FIRST DOSE 2020 -12-28Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-20Pfizer EJ3248 Left arm
C4591008 -1062796864 67/M/WHITE FIRST DOSE 2021 -01-07Pfizer PEJ1686 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073749
Listing 7.7.5 Page 11of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 299of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-28Pfizer PEL3302 Left arm
C4591008 -1065114176 40/F/MULTIPL
EFIRST DOSE 2021 -01-05Moderna 011L20A Left arm
SECOND DOSE 2021 -02-02Moderna 004M20A Left arm
C4591008 -1066244672 55/M/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
C4591008 -1066576448 36// FIRST DOSE 2020 -12-21Pfizer UNKNOWN Left arm
C4591008 -1066629184 60/F/WHITE FIRST DOSE 2020 -12-21Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-13Pfizer EK9231 Left arm
C4591008 -1067346496 34/F/WHITE FIRST DOSE 2021 -01-14Pfizer el0142 Left arm
SECOND DOSE 2021 -02-04Pfizer EL9261 Left arm
C4591008 -1069432384 44/F/WHITE FIRST DOSE 2020 -12-20Pfizer EJ1618 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073750
Listing 7.7.5 Page 12of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 300of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2020 -01-08Pfizer 2021 -01-08 UNKNOWN Left arm
2021 -01-08Pfizer EL1283 Left arm
C4591008 -1074647616 59/M/WHITE FIRST DOSE 2021 -01-28Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-18Pfizer UNKNOWN Left arm
C4591008 -1075850816 54// FIRST DOSE 2021 -01-07Pfizer E23248 Left arm
SECOND DOSE 2021 -01-28Pfizer UNKNOWN Left arm
C4591008 -1078853696 28/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-13Pfizer UNKNOWN Right arm
C4591008 -1080580160 40/F/WHITE FIRST DOSE 2021 -01-21Pfizer EL8982 Left arm
SECOND DOSE 2021 -02-11Pfizer EN9581 Left arm
C4591008 -1081563712 27// SECOND DOSE 2021 -01-18Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073751
Listing 7.7.5 Page 13of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 301of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1081842240 33/F/WHITE FIRST DOSE 2020 -12-16Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-06Pfizer UNKNOWN Left arm
C4591008 -1082831936 28/F/WHITE FIRST DOSE 2021 -01-15Moderna 011L20A Left arm
SECOND DOSE 2021 -02-12Moderna 039K20A Left arm
C4591008 -1084234816 43/F/WHITE FIRST DOSE 2020 -12-26Pfizer EL0140 Right arm
SECOND DOSE 2021 -01-16Pfizer UNKNOWN Right arm
C4591008 -1084765248 62/M/WHITE FIRST DOSE 2020 -12-21Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-14Pfizer EC1283 Left arm
C4591008 -1085324352 47/F/ASIAN FIRST DOSE 2020 -12-17Pfizer EK5730 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073752
Listing 7.7.5 Page 14of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 302of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -1086213184 27/F/ASIAN FIRST DOSE 2021 -01-03Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-24Pfizer UNKNOWN Left arm
C4591008 -1087542848 32/F/WHITE FIRST DOSE 2021 -01-06Pfizer EL1284 Left arm
SECOND DOSE 2021 -01-28Pfizer EL9261 Right arm
C4591008 -1088379456 56/M/WHITE FIRST DOSE 2020 -12-16Pfizer UNKNOWN Left arm
C4591008 -1089123392 38/F/WHITE FIRST DOSE 2020 -12-23Pfizer EJ1685 Right arm
SECOND DOSE 2021 -01-13Pfizer UNKNOWN Left arm
C4591008 -1090491968 31/F/WHITE FIRST DOSE 2021 -01-05Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-05Moderna UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073753
Listing 7.7.5 Page 15of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 303of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1090930240 42/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-07Pfizer EL3246 Left arm
UNKNOWN Left arm
C4591008 -1092611136 49/F/NOT
REPORTEDFIRST DOSE 2021 -01-12Pfizer EL3246 Left arm
SECOND DOSE 2021 -02-02Pfizer UNKNOWN Left arm
C4591008 -1093375552 30/M/ASIAN FIRST DOSE 2020 -12-18Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-05Pfizer EL3246 Left arm
C4591008 -1093640768 34/F/WHITE FIRST DOSE 2020 -12-23Moderna UNKNOWN Right arm
SECOND DOSE 2021 -01-20Moderna 042L20A Right arm
C4591008 -1093973568 40// FIRST DOSE 2020 -12-29Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073754
Listing 7.7.5 Page 16of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 304of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1095222336 41/M/WHITE FIRST DOSE 2020 -12-22Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
C4591008 -1096657472 36/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2020 -12-30Moderna 039K20A Left arm
SECOND DOSE 2021 -01-26Moderna 013L20A Left arm
C4591008 -1097108544 32/F/WHITE FIRST DOSE 2020 -12-05Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Right arm
C4591008 -1097507392 31/M/WHITE FIRST DOSE 2021 -01-04Moderna 025J20A Left arm
SECOND DOSE 2021 -02-04Moderna UNKNOWN Left arm
C4591008 -1100576320 32/M/WHITE FIRST DOSE 2020 -12-21Pfizer EK5730 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073755
Listing 7.7.5 Page 17of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 305of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-13Pfizer EL3248 Left arm
C4591008 -1102117952 42// FIRST DOSE 2020 -12-22Pfizer EL0140 Right arm
C4591008 -1102124608 52/F/WHITE FIRST DOSE 2021 -02-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -03-10Pfizer UNKNOWN Left arm
C4591008 -1103725632 41/F/WHITE FIRST DOSE 2021 -01-06Moderna UNKNOWN Right arm
SECOND DOSE 2021 -02-03Moderna UNKNOWN Right arm
C4591008 -1105233984 35/F/WHITE FIRST DOSE 2021 -04-10Moderna UNKNOWN Left arm
SECOND DOSE 2021 -05-09Moderna UNKNOWN Left arm
C4591008 -1106382400 41/F/WHITE FIRST DOSE 2021 -02-05Pfizer EJ1685 Left arm
SECOND DOSE 2021 -02-28Pfizer UNKNOWN Right arm
C4591008 -1106648640 45/F/WHITE FIRST DOSE 2020 -12-28Pfizer EL1284 Left arm
SECOND DOSE 2021 -01-18Pfizer EL3249 Left arm
C4591008 -1107791936 43/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2020 -12-28Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073756
Listing 7.7.5 Page 18of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 306of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-19Pfizer EL3248 Left arm
C4591008 -1109332032 35//
C4591008 -1109784128 35/F/WHITE FIRST DOSE 2021 -01-05Moderna 037K20A Right arm
SECOND DOSE 2021 -01-29Moderna 042L20A Left arm
C4591008 -1109784640 62/M/WHITE FIRST DOSE 2021 -01-07Moderna 011J20A Left arm
UNKNOWN Left arm
SECOND DOSE 2021 -02-06Moderna 0302L2019 Left arm
0302L2614 Left arm
C4591008 -1113199680 51/F/WHITE FIRST DOSE 2020 -12-18Pfizer E1685 Right arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Right arm
C4591008 -1113876032 58/F/WHITE FIRST DOSE 2021 -01-06Pfizer EK9231 Right arm
SECOND DOSE 2021 -01-27Pfizer EL9261 Right arm
C4591008 -1114062400 41/F/WHITE FIRST DOSE 2021 -01-12Pfizer 4/30/21 Left arm
SECOND DOSE 2021 -02-02Pfizer EL9262 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073757
Listing 7.7.5 Page 19of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 307of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1116473920 23/F/WHITE FIRST DOSE 2021 -01-15Pfizer PfizerEL324
6Left arm
SECOND DOSE 2021 -02-05Pfizer PfizerEL926
4Left arm
C4591008 -1118287424 58/F/WHITE FIRST DOSE 2021 -01-22Moderna 026L20A Left arm
SECOND DOSE 2021 -02-22Moderna UNKNOWN Left arm
C4591008 -1120833088 37//
C4591008 -1121954368 32/F/WHITE FIRST DOSE 2021 -01-27Pfizer EN5318 Right arm
SECOND DOSE 2021 -02-17Pfizer EL9266 Right arm
C4591008 -1123123776 56/M/WHITE FIRST DOSE 2021 -01-17Moderna 012L20A Left arm
SECOND DOSE 2021 -02-14Moderna 024M20A Left arm
C4591008 -1124744768 62//
C4591008 -1125933632 29/F/WHITE FIRST DOSE 2021 -03-18Pfizer ER2613 Right arm
SECOND DOSE 2021 -04-09Pfizer UNKNOWN Left arm
C4591008 -1126712384 48/M/WHITE FIRST DOSE 2020 -12-23Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-13Pfizer EL0142 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073758
Listing 7.7.5 Page 20of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 308of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1127004224 22// FIRST DOSE 2021 -01-06Pfizer UNKNOWN Left arm
C4591008 -1127043648 56/F/WHITE FIRST DOSE 2021 -01-05Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-25Pfizer UNKNOWN Left arm
C4591008 -1127562304 60/F/WHITE FIRST DOSE 2021 -01-25Pfizer EL9262 Right arm
SECOND DOSE 2021 -02-17Pfizer EL9262 Right arm
C4591008 -1129966656 50/M/WHITE FIRST DOSE 2020 -12-31Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-27Pfizer UNKNOWN Left arm
C4591008 -1130590784 33/F/WHITE FIRST DOSE 2020 -12-20Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-09Pfizer EK9231 Arm (side
unknown)
C4591008 -1131641408 45/F/WHITE FIRST DOSE 2020 -12-21Pfizer EH98993121 Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073759
Listing 7.7.5 Page 21of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 309of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1132219456 26/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -04-06Pfizer ER8737 Right arm
C4591008 -1133115968 21/F/WHITE FIRST DOSE 2021 -01-05Pfizer EK9231 Left arm
C4591008 -1133606976 28//
C4591008 -1134310976 50/F/WHITE FIRST DOSE 2020 -12-28Moderna 039K20A Left arm
SECOND DOSE 2021 -01-25Moderna UNKNOWN Left arm
C4591008 -1134830144 38/F/WHITE FIRST DOSE 2020 -12-18Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-06Pfizer EL3246 Right arm
C4591008 -1135561280 36//
C4591008 -1135687232 22/F/WHITE FIRST DOSE 2021 -04-09Moderna UNKNOWN Left arm
C4591008 -1135732800 63/F/WHITE FIRST DOSE 2020 -12-22Pfizer EH9899 Right arm
SECOND DOSE 2021 -01-12Pfizer EH9899 Right arm
C4591008 -1136676928 26/F/WHITE FIRST DOSE 2021 -01-02Pfizer EH9899 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073760
Listing 7.7.5 Page 22of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 310of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-23Pfizer EL3248 Left arm
C4591008 -1137200704 32//
C4591008 -1138084416 48//
C4591008 -1139161664 20/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
C4591008 -1142895168 44/F/WHITE FIRST DOSE 2020 -12-16Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-06Pfizer EL1283 Right arm
C4591008 -1145446464 36/F/WHITE FIRST DOSE 2020 -12-21Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Right arm
C4591008 -1145765440 60/M/WHITE FIRST DOSE 2021 -01-22Pfizer EL3247 Left arm
SECOND DOSE 2021 -02-12Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073761
Listing 7.7.5 Page 23of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 311of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1146082880 51/M/WHITE FIRST DOSE 2020 -12-15Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-05Pfizer EK9231 Other
C4591008 -1146102848 45/F/WHITE FIRST DOSE 2021 -02-27Moderna UNKNOWN Left arm
SECOND DOSE 2021 -03-25Moderna UNKNOWN Left arm
C4591008 -1146322496 25/F/WHITE FIRST DOSE 2021 -01-05Pfizer Ej1686 Left arm
SECOND DOSE 2021 -01-26Pfizer UNKNOWN Right arm
C4591008 -1147386432 67/F/WHITE FIRST DOSE 2020 -12-23Moderna 025J20 -2A Left arm
SECOND DOSE 2021 -01-19Moderna 042L20A Left arm
2021 -01-20Moderna 2021 -01-19 UNKNOWN Right arm
C4591008 -1150614592 42/F/WHITE FIRST DOSE 2020 -12-16Pfizer EK5730 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073762
Listing 7.7.5 Page 24of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 312of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Right arm
C4591008 -1150880832 43/F/WHITE FIRST DOSE 2020 -12-22Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Right arm
C4591008 -1152247872 36/F/AMERICA
N INDIAN OR
ALASKAFIRST DOSE 2021 -01-14Pfizer EK9231 Left arm
SECOND DOSE 2021 -02-04Pfizer EM9810 Left arm
C4591008 -1154759744 72/F/WHITE FIRST DOSE 2020 -12-21Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
C4591008 -1154958400 47/F/WHITE FIRST DOSE 2020 -12-22Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-09Pfizer UNKNOWN Right arm
C4591008 -1156407872 31// FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
C4591008 -1156792896 30/F/WHITE FIRST DOSE 2020 -12-29Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-19Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073763
Listing 7.7.5 Page 25of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 313of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1157098560 41// FIRST DOSE 2020 -12-17Pfizer Not available Right arm
C4591008 -1157444160 35/F/ASIAN FIRST DOSE 2020 -12-23Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-14Pfizer el3247 Left arm
C4591008 -1157722176 37/F/WHITE FIRST DOSE 2020 -12-27Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-16Pfizer EL3302 Left arm
C4591008 -1157749824 48/M/WHITE FIRST DOSE 2020 -12-29Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-26Moderna UNKNOWN Left arm
C4591008 -1158440000 34/F/WHITE FIRST DOSE 2020 -12-20Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-06Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073764
Listing 7.7.5 Page 26of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 314of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1159317568 41/F/WHITE FIRST DOSE 2021 -01-26Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-26Pfizer 2021 -02-16 UNKNOWN Left arm
2021 -02-16Pfizer UNKNOWN Left arm
C4591008 -1163396672 37/M/WHITE FIRST DOSE 2021 -01-06Moderna 026L02A Left arm
SECOND DOSE 2021 -02-03Moderna 029L20A Left arm
C4591008 -1164365888 61/M/WHITE FIRST DOSE 2021 -01-22Pfizer el1283 Left arm
SECOND DOSE 2021 -02-13Pfizer en9581 Left arm
C4591008 -1165468224 45/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2020 -12-05Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-17Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073765
Listing 7.7.5 Page 27of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 315of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1166052928 53/M/WHITE FIRST DOSE 2020 -12-31Moderna 026L20A Left arm
SECOND DOSE 2021 -01-28Moderna 012L29A Right arm
C4591008 -1170238528 38/F/ASIAN FIRST DOSE 2021 -01-07Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-28Pfizer UNKNOWN Left arm
C4591008 -1170239040 51/F/WHITE FIRST DOSE 2020 -12-11Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Right arm
C4591008 -1170318400 30/F/WHITE FIRST DOSE 2021 -02-01Moderna UNKNOWN Left arm
SECOND DOSE 2021 -03-01Moderna UNKNOWN Right arm
C4591008 -1170650176 32/F/WHITE FIRST DOSE 2020 -12-18Pfizer EJ1685 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073766
Listing 7.7.5 Page 28of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 316of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-08Pfizer EJ1686 Left arm
C4591008 -1171633216 64//
C4591008 -1172191296 31/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-09Pfizer UNKNOWN Left arm
C4591008 -1174317632 37/F/WHITE FIRST DOSE 2020 -12-20Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Right arm
C4591008 -1175300160 31/F/WHITE FIRST DOSE 2020 -12-30Pfizer Ej1685 Left arm
SECOND DOSE 2021 -01-19Pfizer UNKNOWN Left arm
C4591008 -1175539264 52/F/WHITE FIRST DOSE 2020 -12-19Pfizer EJ1865 Left arm
SECOND DOSE 2021 -01-09Pfizer EL3302 Right arm
C4591008 -1175978048 36/F/WHITE FIRST DOSE 2021 -01-14Pfizer EL1283 Right arm
SECOND DOSE 2021 -02-05Pfizer EN9581 Left arm
C4591008 -1178097728 35/F/WHITE FIRST DOSE 2021 -02-20Moderna UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073767
Listing 7.7.5 Page 29of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 317of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -03-20Moderna UNKNOWN Right arm
C4591008 -1180775488 60/F/WHITE FIRST DOSE 2021 -01-04Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-22Pfizer UNKNOWN Left arm
C4591008 -1182010944 49/F/WHITE FIRST DOSE 2020 -12-23Moderna 039K20A Left arm
SECOND DOSE 2021 -01-22Moderna 028620A Left arm
C4591008 -1183579200 25//
C4591008 -1183724096 36/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-09Pfizer EL1284 Left arm
C4591008 -1183950912 34/F/WHITE FIRST DOSE 2020 -12-23Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-13Pfizer EL1283 Right arm
C4591008 -1184056896 41// FIRST DOSE 2020 -12-28Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-19Pfizer UNKNOWN Left arm
C4591008 -1184415808 51/F/WHITE FIRST DOSE 2020 -12-18Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-08Pfizer EK923 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073768
Listing 7.7.5 Page 30of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 318of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
EK9231 Left arm
C4591008 -1184959552 33/F/WHITE FIRST DOSE 2020 -12-22Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -1185850944 39//
C4591008 -1187378240 36/F/WHITE FIRST DOSE 2020 -12-14Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-05Pfizer EK9321 Left arm
C4591008 -1188772928 55/F/ASIAN FIRST DOSE 2020 -12-26Moderna 0115200A Left arm
SECOND DOSE 2021 -01-23Moderna 029L20A Left arm
C4591008 -1190075968 45/F/WHITE FIRST DOSE 2020 -12-22Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-01Pfizer UNKNOWN Arm (side
unknown)
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073769
Listing 7.7.5 Page 31of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 319of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1190514752 26/F/WHITE FIRST DOSE 2020 -12-28Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-18Pfizer EL3249 Left arm
C4591008 -1191151168 29/F/WHITE FIRST DOSE 2021 -01-05Pfizer EK9231 Left arm
C4591008 -1198831680 48/M/WHITE FIRST DOSE 2020 -12-20Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
C4591008 -1199376448 63/F/WHITE FIRST DOSE 2021 -01-05Pfizer EK9231 Right arm
SECOND DOSE 2021 -01-26Pfizer EL3247 Right arm
C4591008 -1200931392 62//
C4591008 -1202259008 36/F/WHITE FIRST DOSE 2020 -12-22Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-12Pfizer EL3248 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073770
Listing 7.7.5 Page 32of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 320of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1202857536 41/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-05Pfizer UNKNOWN Left arm
C4591008 -1203920448 35/F/WHITE FIRST DOSE 2020 -12-15Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-04Pfizer EH9899 Left arm
eh9899 Left arm
C4591008 -1205435456 40// FIRST DOSE 2020 -12-18Pfizer EH9899 Left arm
C4591008 -1206870080 31/M/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2020 -12-18Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-10Pfizer EL1283 Left arm
el1283 Left arm
C4591008 -1208012864 31/F/WHITE FIRST DOSE 2020 -12-15Pfizer EH9899 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073771
Listing 7.7.5 Page 33of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 321of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-05Pfizer UNKNOWN Left arm
C4591008 -1208770624 48/F/WHITE FIRST DOSE 2020 -12-19Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-09Pfizer EL3248 Left arm
El3248 Left arm
C4591008 -1211454528 26// FIRST DOSE 2021 -01-15Pfizer EL3248 Left arm
C4591008 -1211772480 35/F/ASIAN FIRST DOSE 2020 -12-29Pfizer Ek5730 Left arm
SECOND DOSE 2021 -02-15Pfizer UNKNOWN Left arm
C4591008 -1212357696 49/F/WHITE FIRST DOSE 2020 -12-17Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-07Pfizer EK5730 Right arm
C4591008 -1212728896 37/F/WHITE FIRST DOSE 2020 -12-23Pfizer EL 1284 Left arm
SECOND DOSE 2021 -01-13Pfizer EL 3248 Left arm
C4591008 -1212782656 34/M/WHITE FIRST DOSE 2021 -01-12Moderna 039K20A Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073772
Listing 7.7.5 Page 34of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 322of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-09Moderna 028220A Left arm
2021 -03-09Moderna 2021 -02-09 UNKNOWN Right arm
C4591008 -1218548288 25/M/MULTIPL
EFIRST DOSE 2021 -01-13Pfizer EL1283 Left arm
SECOND DOSE 2021 -02-03Pfizer EL9264 Left arm
C4591008 -1218940480 33// SECOND DOSE 2021 -03-26Moderna UNKNOWN Right arm
C4591008 -1219864128 48/M/WHITE FIRST DOSE 2020 -12-16Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-06Pfizer UNKNOWN Left arm
C4591008 -1222110272 32/F/WHITE FIRST DOSE 2021 -01-09Pfizer EL3248 Right arm
SECOND DOSE 2021 -01-29Pfizer EN5318 Right arm
C4591008 -1223438400 41/M/WHITE FIRST DOSE 2021 -01-13Moderna 012L20A Left arm
SECOND DOSE 2021 -02-10Moderna 028L201A Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073773
Listing 7.7.5 Page 35of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 323of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1226335296 41/F/WHITE FIRST DOSE 2021 -01-04Pfizer EJ1685 Right arm
SECOND DOSE 2021 -01-26Pfizer EL3246 Right arm
C4591008 -1229018688 32//
C4591008 -1229298240 40// FIRST DOSE 2020 -12-17Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -1230613568 36/F/WHITE FIRST DOSE 2020 -12-30Pfizer EH9899 Left arm
C4591008 -1230958656 33/M/WHITE FIRST DOSE 2020 -12-29Pfizer EK 5730 Left arm
SECOND DOSE 2021 -01-25Pfizer EL3249 Left arm
C4591008 -1231184960 33/F/WHITE FIRST DOSE 2020 -12-17Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-07Pfizer EK9231 Right arm
UNKNOWN Right arm
C4591008 -1240630848 43/F/WHITE FIRST DOSE 2021 -01-03Pfizer EL1284 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073774
Listing 7.7.5 Page 36of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 324of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-24Pfizer EL3249 Right arm
C4591008 -1241441856 40/F/WHITE FIRST DOSE 2020 -12-21Pfizer ej1685 Left arm
SECOND DOSE 2021 -01-07Pfizer EJ1686 Arm (side
unknown)
C4591008 -1242065984 57/F/WHITE FIRST DOSE 2021 -01-13Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-10Moderna UNKNOWN Right arm
C4591008 -1242305600 30/F/WHITE FIRST DOSE 2020 -12-30Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-20Pfizer EL3248 Left arm
C4591008 -1242637376 40// FIRST DOSE 2021 -01-04Pfizer EL0142 Left arm
SECOND DOSE 2021 -01-25Pfizer EL9262 Left arm
C4591008 -1246922816 31//
C4591008 -1248975936 52// FIRST DOSE 2021 -02-04Pfizer UNKNOWN Left arm
C4591008 -1254662208 51/F/WHITE FIRST DOSE 2021 -01-29Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-19Pfizer EN6201 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073775
Listing 7.7.5 Page 37of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 325of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1255326784 30/F/WHITE FIRST DOSE 2020 -12-27Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-17Pfizer EL1283 Left arm
C4591008 -1256893504 23// FIRST DOSE 2021 -01-25Moderna 025J20A Left arm
C4591008 -1257059904 38// FIRST DOSE 2021 -04-05Pfizer UNKNOWN Left arm
C4591008 -1257956416 34/M/WHITE FIRST DOSE 2021 -01-06Moderna UNKNOWN Right arm
SECOND DOSE 2021 -02-04Moderna UNKNOWN Right arm
C4591008 -1260135488 63/M/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-13Pfizer EK9231 Right arm
C4591008 -1261000256 45//
C4591008 -1262859840 40/F/WHITE FIRST DOSE 2020 -12-21Pfizer EL0140 Right arm
SECOND DOSE 2021 -01-11Pfizer EK9231 Left arm
C4591008 -1265702976 32/F/WHITE FIRST DOSE 2020 -12-28Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-21Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073776
Listing 7.7.5 Page 38of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 326of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1267855424 44/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-07Pfizer UNKNOWN Left arm
C4591008 -1272398912 29/F/WHITE FIRST DOSE 2020 -12-30Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-26Moderna UNKNOWN Left arm
C4591008 -1272691776 35/F/WHITE FIRST DOSE 2020 -12-21Pfizer EJ1685 Right arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Right arm
C4591008 -1272851520 39/F/WHITE FIRST DOSE 2020 -12-19Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-07Pfizer Don't m ow Left arm
C4591008 -1273528896 39/F/MULTIPL
EFIRST DOSE 2021 -02-05Pfizer EL9264 Left arm
SECOND DOSE 2021 -02-26Pfizer EN6203 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073777
Listing 7.7.5 Page 39of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 327of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1277487680 46/M/ASIAN FIRST DOSE 2020 -12-22Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-12Pfizer EL3248 Left arm
C4591008 -1278936640 23/F/WHITE FIRST DOSE 2020 -12-31Moderna UNKNOWN Right arm
SECOND DOSE 2021 -01-28Moderna UNKNOWN Right arm
C4591008 -1280438848 26/F/WHITE FIRST DOSE 2020 -12-18Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-08Pfizer EK9231 Left arm
C4591008 -1282643520 45/F/WHITE FIRST DOSE 2021 -01-04Pfizer EL1284 Left arm
SECOND DOSE 2021 -01-29Pfizer EL9265 Left arm
C4591008 -1282736704 43/F/WHITE FIRST DOSE 2020 -12-22Pfizer EJ1685 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073778
Listing 7.7.5 Page 40of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 328of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-01Pfizer UNKNOWN Right arm
2021 -01-11Pfizer 2021 -01-01 UNKNOWN Right arm
C4591008 -1288144448 60/F/WHITE FIRST DOSE 2021 -01-14Pfizer EL3248 Left arm
SECOND DOSE 2021 -02-04Pfizer EL8982 Left arm
C4591008 -1288888896 67/F/WHITE FIRST DOSE 2021 -01-06Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-25Pfizer UNKNOWN Left arm
C4591008 -1289153600 36/M/WHITE FIRST DOSE 2021 -01-08Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-08Moderna UNKNOWN Left arm
C4591008 -1289299520 52/F/WHITE FIRST DOSE 2020 -12-23Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-13Pfizer EL 1283 Left arm
C4591008 -1290496064 49/F/MULTIPL
EFIRST DOSE 2020 -12-21Pfizer EK5730 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073779
Listing 7.7.5 Page 41of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 329of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Right arm
C4591008 -1290655296 36/M/MULTIPL
EFIRST DOSE 2020 -12-15Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-06Pfizer EL 9899 Right arm
C4591008 -1295790656 30// FIRST DOSE 2021 -02-11Moderna 024M20A Left arm
C4591008 -1297006656 34/F/WHITE FIRST DOSE 2020 -12-29Pfizer EL1284 Left arm
SECOND DOSE 2021 -01-19Pfizer EL1283 Left arm
C4591008 -1297033792 53/F/WHITE FIRST DOSE 2020 -12-16Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-07Pfizer UNKNOWN Left arm
C4591008 -1297073216 57/M/WHITE FIRST DOSE 2020 -12-17Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-07Pfizer EL1284 Right arm
C4591008 -1297271872 44/M/WHITE FIRST DOSE 2020 -12-28Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-18Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073780
Listing 7.7.5 Page 42of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 330of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1297404992 34/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2020 -12-20Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-10Pfizer UNKNOWN Left arm
C4591008 -1297444928 28/M/WHITE FIRST DOSE 2021 -01-02Moderna 039K20A Left arm
SECOND DOSE 2021 -01-29Moderna 028L20A Left arm
C4591008 -1299624000 23/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -02-05Pfizer EL9264 Left arm
SECOND DOSE 2021 -02-26Pfizer UNKNOWN Left arm
C4591008 -1301644352 52/F/WHITE FIRST DOSE 2020 -12-28Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-21Pfizer UNKNOWN Left arm
C4591008 -1305616960 67/M/WHITE FIRST DOSE 2021 -01-04Moderna UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073781
Listing 7.7.5 Page 43of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 331of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-02Moderna UNKNOWN Left arm
C4591008 -1305669696 35/M/WHITE FIRST DOSE 2020 -12-28Pfizer EJ1686 Left arm
SECOND DOSE 2021 -01-19Pfizer EL1283 Left arm
C4591008 -1306387008 58/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-08Pfizer EK9231 Left arm
C4591008 -1306785856 35/F/NOT
REPORTEDFIRST DOSE 2020 -12-23Moderna 025J20 -2A Right arm
SECOND DOSE 2021 -01-22Moderna UNKNOWN Left arm
Unknown
C4591008 -1307795520 33/F/WHITE FIRST DOSE 2020 -12-21Pfizer Ej1685 Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073782
Listing 7.7.5 Page 44of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 332of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1308472384 39/F/WHITE FIRST DOSE 2021 -01-15Pfizer EL1284 Right arm
SECOND DOSE 2021 -02-03Pfizer EL9263 Right arm
C4591008 -1309708864 61/M/WHITE FIRST DOSE 2020 -12-17Pfizer EH9889 Left arm
SECOND DOSE 2021 -01-07Pfizer UNKNOWN Left arm
C4591008 -1309774400 29/F/AMERICA
N INDIAN OR
ALASKAFIRST DOSE 2021 -01-19Pfizer EL3248 Left arm
SECOND DOSE 2021 -02-09Pfizer EN5318 Left arm
C4591008 -1309787712 61// FIRST DOSE 2020 -12-18Pfizer UNKNOWN Left arm
C4591008 -1310585920 37// FIRST DOSE 2020 -12-19Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-07Pfizer UNKNOWN Right arm
C4591008 -1311277120 32/F/WHITE FIRST DOSE 2020 -12-23Moderna 037KZ0A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073783
Listing 7.7.5 Page 45of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 333of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-26Moderna 042L20A Left arm
C4591008 -1312007232 33/F/WHITE FIRST DOSE 2021 -01-08Moderna 025L20A Left arm
SECOND DOSE 2021 -02-05Moderna 010M20A Left arm
C4591008 -1312406080 28/M/NOT
REPORTEDFIRST DOSE 2021 -01-14Moderna 037K208 Right arm
SECOND DOSE 2021 -02-22Moderna UNKNOWN Right arm
C4591008 -1313396288 35/F/ASIAN FIRST DOSE 2021 -03-27Pfizer EP 6955 Left arm
SECOND DOSE 2021 -04-18Pfizer ep8751 Left arm
C4591008 -1313614400 31// FIRST DOSE 2020 -12-17Pfizer EH9899 Right arm
C4591008 -1315275840 57/F/WHITE FIRST DOSE 2021 -01-14Pfizer EK4176 Right arm
SECOND DOSE 2021 -02-22Pfizer UNKNOWN Right arm
C4591008 -1316259392 54/F/WHITE FIRST DOSE 2021 -01-08Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-08Pfizer Ek9231 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073784
Listing 7.7.5 Page 46of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 334of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1321333824 46/F/WHITE FIRST DOSE 2021 -01-07Pfizer EL1283 Right arm
SECOND DOSE 2021 -01-28Pfizer EL3247 Left arm
C4591008 -1322277952 72/F/WHITE FIRST DOSE 2021 -01-19Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -02-09Pfizer UNKNOWN Right arm
C4591008 -1322410048 36/F/WHITE FIRST DOSE 2020 -12-22Pfizer EL1284 Left arm
SECOND DOSE 2021 -01-13Pfizer EL3248 Right arm
C4591008 -1324150848 36/F/WHITE FIRST DOSE 2021 -01-13Pfizer EL 3248 Left arm
SECOND DOSE 2021 -02-03Pfizer EN 5318 Left arm
C4591008 -1325572160 40/M/WHITE FIRST DOSE 2020 -12-21Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-08Pfizer EL3246 Left arm
C4591008 -1325626432 32/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073785
Listing 7.7.5 Page 47of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 335of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1327432768 63// FIRST DOSE 2020 -12-21Pfizer EH9899 Right arm
C4591008 -1329346112 41/F/WHITE FIRST DOSE 2020 -12-15Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-04Pfizer EK9231 Left arm
2021 -01-05Pfizer 2021 -01-04 Idk Left arm
C4591008 -1329624640 35//
C4591008 -1329784384 45/F/WHITE FIRST DOSE 2021 -01-20Moderna 029L20A Left arm
SECOND DOSE 2021 -02-17Moderna 004M20A Right arm
C4591008 -1331778112 49/F/WHITE FIRST DOSE 2020 -12-27Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
2021 -01-11Pfizer 2021 -01-08 UNKNOWN Left arm
C4591008 -1332813888 48/F/WHITE FIRST DOSE 2021 -01-22Pfizer EL3247 Right arm
SECOND DOSE 2021 -02-18Pfizer EL9269 Left arm
C4591008 -1335937088 38// FIRST DOSE 2020 -12-20Pfizer EX5730 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073786
Listing 7.7.5 Page 48of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 336of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-08Pfizer EL3248 Left arm
C4591008 -1337730624 32/F/WHITE FIRST DOSE 2021 -01-28Pfizer EL3247 Left arm
SECOND DOSE 2021 -02-19Pfizer EN6201 Left arm
C4591008 -1337862208 40/F/WHITE FIRST DOSE 2021 -01-04Pfizer Pfizer EK
5730Left arm
SECOND DOSE 2021 -01-26Pfizer EL3248 Left arm
C4591008 -1340095040 42/F/MULTIPL
EFIRST DOSE 2020 -12-26Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-16Pfizer EL8982 Left arm
C4591008 -1340280384 43/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-04Pfizer UNKNOWN Left arm
C4591008 -1340613184 51/F/WHITE FIRST DOSE 2021 -01-05Pfizer EK9231 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073787
Listing 7.7.5 Page 49of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 337of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-26Pfizer EL8a82 Left arm
C4591008 -1340720192 37/F/WHITE FIRST DOSE 2020 -12-22Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-12Pfizer EL1283 Left arm
C4591008 -1342499904 40/F/WHITE FIRST DOSE 2020 -12-27Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-17Pfizer EL3302 Left arm
C4591008 -1342818368 28/M/WHITE FIRST DOSE 2020 -12-29Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-21Pfizer UNKNOWN Left arm
C4591008 -1343416384 47/F/WHITE FIRST DOSE 2021 -01-04Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-28Pfizer EL3246 Left arm
C4591008 -1344666176 46/F/WHITE FIRST DOSE 2021 -01-07Pfizer EL0140 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073788
Listing 7.7.5 Page 50of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 338of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1345542208 78/M/WHITE FIRST DOSE 2020 -12-21Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-14Pfizer EL1284 Right arm
C4591008 -1346312768 33/F/WHITE FIRST DOSE 2020 -12-21Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-12Pfizer EL1284 Left arm
C4591008 -1349262400 56/F/WHITE FIRST DOSE 2021 -01-13Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-09Moderna UNKNOWN Left arm
C4591008 -1350498368 62/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-14Pfizer UNKNOWN Left arm
C4591008 -1350511680 28/F/WHITE FIRST DOSE 2021 -01-08Moderna 011L20A Left arm
SECOND DOSE 2021 -02-05Moderna 021M20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073789
Listing 7.7.5 Page 51of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 339of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1351402560 50/F/WHITE FIRST DOSE 2020 -12-23Moderna 011J20A Left arm
SECOND DOSE 2021 -01-20Moderna 013L20A Left arm
C4591008 -1351866432 39/F/WHITE FIRST DOSE 2021 -02-04Pfizer EL9264 Left arm
SECOND DOSE 2021 -02-25Pfizer EN6203 Left arm
UNKNOWN Left arm
C4591008 -1352079936 57/M/WHITE FIRST DOSE 2020 -12-20Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-10Pfizer EK5730 Left arm
C4591008 -1352358976 31/F/WHITE FIRST DOSE 2020 -12-19Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-13Pfizer 2021 -01-19 UNKNOWN Arm (side
unknown)
2021 -01-19Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073790
Listing 7.7.5 Page 52of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 340of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1352518208 34/F/WHITE FIRST DOSE 2020 -12-19Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-08Pfizer EK9231 Left arm
C4591008 -1354723904 48/F/WHITE FIRST DOSE 2020 -12-29Moderna 025J20 -2A Left arm
SECOND DOSE 2021 -01-27Moderna 2021 -01-29 042L20A Left arm
2021 -01-29Moderna 042L20A Left arm
C4591008 -1356132416 39//
C4591008 -1356995136 58/F/WHITE FIRST DOSE 2020 -12-21Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-11Pfizer EJ1685 Left arm
C4591008 -1358801984 48/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Right arm
C4591008 -1359254080 40/F/WHITE FIRST DOSE 2020 -12-28Moderna 026L20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073791
Listing 7.7.5 Page 53of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 341of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-27Moderna 030L20A Left arm
C4591008 -1359381056 39// FIRST DOSE 2021 -04-05Pfizer ER8732 Left arm
C4591008 -1359971904 61/F/WHITE FIRST DOSE 2020 -12-23Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-13Pfizer EL3302 Left arm
C4591008 -1361034304 60/M/WHITE FIRST DOSE 2020 -12-19Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-09Pfizer EL0142 Left arm
C4591008 -1361234496 43/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2020 -12-17Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-04Pfizer el0140 Right arm
C4591008 -1362363968 31/F/WHITE FIRST DOSE 2020 -12-31Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-20Pfizer UNKNOWN Right arm
C4591008 -1366322752 28//
C4591008 -1366641216 23/F/WHITE FIRST DOSE 2021 -01-29Pfizer EL898205/20
21Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073792
Listing 7.7.5 Page 54of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 342of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-17Pfizer EL9265
05/2021Right arm
C4591008 -1369564224 63/F/WHITE FIRST DOSE 2020 -12-22Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Right arm
C4591008 -1369829952 43/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2020 -12-24Moderna 026L20A Left arm
SECOND DOSE 2021 -01-21Moderna 032L20A Right arm
C4591008 -1371756608 48/M/WHITE FIRST DOSE 2020 -12-22Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
C4591008 -1374002752 45/F/WHITE FIRST DOSE 2020 -12-29Moderna 025J20A Right arm
SECOND DOSE 2021 -02-28Moderna UNKNOWN Right arm
C4591008 -1374241856 35/F/WHITE FIRST DOSE 2021 -01-21Moderna 030L20A Left arm
SECOND DOSE 2021 -02-20Moderna UNKNOWN Left arm
C4591008 -1374654016 36/F/WHITE FIRST DOSE 2020 -12-30Pfizer EK9231 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073793
Listing 7.7.5 Page 55of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 343of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-25Pfizer EL9262 Left arm
C4591008 -1376414272 27/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -02-15Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -03-08Pfizer UNKNOWN Right arm
C4591008 -1376434752 39// FIRST DOSE 2020 -12-18Pfizer EJ1685 Left arm
C4591008 -1376526400 30// FIRST DOSE 2021 -02-23Moderna UNKNOWN Left arm
C4591008 -1376805440 54/F/WHITE FIRST DOSE 2020 -12-22Pfizer EH9899 Right arm
SECOND DOSE 2021 -01-12Pfizer EL0142 Right arm
C4591008 -1377643584 50/F/WHITE FIRST DOSE 2021 -01-26Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-16Pfizer UNKNOWN Right arm
C4591008 -1378373696 40//
C4591008 -1378573376 38/F/MULTIPL
EFIRST DOSE 2020 -12-18Pfizer Ek5730 Left arm
SECOND DOSE 2021 -01-08Pfizer EL3249 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073794
Listing 7.7.5 Page 56of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 344of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1379874880 67/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -1380858944 62/M/WHITE FIRST DOSE 2021 -01-02Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-23Pfizer UNKNOWN Right arm
C4591008 -1384153152 27/F/WHITE FIRST DOSE 2020 -12-21Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
C4591008 -1385628736 33/F/WHITE FIRST DOSE 2020 -12-20Pfizer EH9899 Left arm
C4591008 -1389972544 45/M/WHITE FIRST DOSE 2020 -12-31Moderna 025J20A Left arm
SECOND DOSE 2021 -02-02Moderna 028L2OA Left arm
C4591008 -1391049280 38/F/WHITE FIRST DOSE 2020 -12-23Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-12Pfizer EL0140 Left arm
C4591008 -1392856128 57/F/ASIAN FIRST DOSE 2020 -12-17Pfizer EK5730 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073795
Listing 7.7.5 Page 57of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 345of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
2021 -01-09Pfizer 2021 -01-08 EL3248 Left arm
C4591008 -1394344000 36/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-18Pfizer I don't know Right arm
C4591008 -1395009088 23// FIRST DOSE 2021 -01-02Pfizer EJ1686 Right arm
C4591008 -1395447360 39/M/WHITE FIRST DOSE 2021 -01-04Moderna 039k20a Left arm
SECOND DOSE 2021 -02-02Moderna 028l20a Right arm
C4591008 -1395474496 35/F/WHITE FIRST DOSE 2020 -12-31Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-19Pfizer EL3248 Left arm
UNKNOWN Right arm
C4591008 -1396609088 49/F/WHITE FIRST DOSE 2021 -01-22Moderna 029L20A Left arm
SECOND DOSE 2021 -02-17Moderna EL9294 Left arm
C4591008 -1397094976 57/F/WHITE FIRST DOSE 2021 -01-06Pfizer EK9231 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073796
Listing 7.7.5 Page 58of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 346of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-27Pfizer EL3302 Right arm
C4591008 -1397892672 29/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-05Pfizer UNKNOWN Left arm
C4591008 -1399035456 30/F/WHITE FIRST DOSE 2021 -01-07Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-28Pfizer EN9581 Left arm
C4591008 -1400350784 50/F/WHITE FIRST DOSE 2020 -12-24Pfizer EK9231 Right arm
SECOND DOSE 2021 -01-17Pfizer el3247 Right arm
C4591008 -1403657792 45/F/WHITE FIRST DOSE 2020 -12-30Pfizer UNKNOWN Left arm
SECOND DOSE 2020 -01-20Pfizer 2021 -01-29 UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073797
Listing 7.7.5 Page 59of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 347of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
2021 -01-29Pfizer UNKNOWN Left arm
C4591008 -1404801600 36/F/WHITE FIRST DOSE 2021 -01-15Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-04Pfizer UNKNOWN Left arm
C4591008 -1405412416 37//
C4591008 -1406142528 60/M/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-08Pfizer EK4176 Right arm
C4591008 -1406236736 33/F/WHITE FIRST DOSE 2021 -01-11Pfizer EL0142 Left arm
SECOND DOSE 2021 -01-29Pfizer UNKNOWN Left arm
Unknown Left arm
C4591008 -1406421568 45/F/WHITE FIRST DOSE 2021 -01-02Pfizer EK9231 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073798
Listing 7.7.5 Page 60of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 348of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-21Pfizer EL3249 Left arm
C4591008 -1406462016 53/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -1406648384 60// FIRST DOSE 2021 -01-04Moderna 039K2OA Left arm
C4591008 -1406661184 46/F/ASIAN FIRST DOSE 2020 -12-30Moderna 026620A Left arm
SECOND DOSE 2021 -01-28Moderna 013L20A Left arm
C4591008 -1407085632 38//
C4591008 -1407498816 55/F/WHITE FIRST DOSE 2020 -12-30Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-28Moderna UNKNOWN Left arm
C4591008 -1407816768 23/M/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2020 -12-16Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-06Pfizer EL1284 Left arm
C4591008 -1408681536 39/M/WHITE FIRST DOSE 2020 -12-26Moderna Unknown Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073799
Listing 7.7.5 Page 61of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 349of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-16Moderna unknown Left arm
C4591008 -1411112000 54//
C4591008 -1411378752 57/F/WHITE FIRST DOSE 2020 -12-28Moderna 02UL20A Left arm
SECOND DOSE 2021 -01-25Moderna UNKNOWN Left arm
C4591008 -1412825664 51/F/WHITE FIRST DOSE 2021 -01-07Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -02-04Pfizer UNKNOWN Left arm
C4591008 -1414407232 63/M/WHITE FIRST DOSE 2020 -12-23Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-13Pfizer Pfizer
EK4176Left arm
C4591008 -1414819392 25// FIRST DOSE 2021 -01-08Pfizer EL3248 Left arm
C4591008 -1415271488 50/F/WHITE FIRST DOSE 2021 -01-07Moderna Don't know Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073800
Listing 7.7.5 Page 62of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 350of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-05Moderna UNKNOWN Right arm
C4591008 -1418206784 63/M/WHITE FIRST DOSE 2020 -12-24Moderna 011J20A Right arm
SECOND DOSE 2021 -01-21Moderna 026L20A Left arm
C4591008 -1418526272 46/F/WHITE FIRST DOSE 2021 -01-07Moderna 012L20A Left arm
SECOND DOSE 2021 -02-04Moderna 031L20A Left arm
C4591008 -1418724928 28/F/WHITE FIRST DOSE 2021 -01-05Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-28Pfizer EL3247 Left arm
C4591008 -1419522112 43/F/WHITE FIRST DOSE 2020 -12-22Moderna 011J20A Right arm
SECOND DOSE 2021 -01-19Moderna 011J2OA Right arm
C4591008 -1420200512 56/F/WHITE FIRST DOSE 2020 -12-31Moderna 039K20 -2A Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073801
Listing 7.7.5 Page 63of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 351of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-28Moderna UNKNOWN Right arm
C4591008 -1421210688 28/F/WHITE FIRST DOSE 2020 -12-23Moderna 025J20 -2A Right arm
SECOND DOSE 2021 -01-27Moderna 042L20A Right arm
C4591008 -1423243328 34/F/MULTIPL
EFIRST DOSE 2020 -12-21Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-13Pfizer UNKNOWN Left arm
C4591008 -1425754688 31// FIRST DOSE 2020 -12-18Pfizer EK5730 Left arm
C4591008 -1428264512 36/F/WHITE FIRST DOSE 2020 -12-17Pfizer 1284 Left arm
SECOND DOSE 2021 -01-07Pfizer EL1284 Left arm
C4591008 -1428956736 31/F/WHITE FIRST DOSE 2020 -12-23Pfizer EH9899 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073802
Listing 7.7.5 Page 64of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 352of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Left arm
ek9231 Right arm
C4591008 -1429049408 41// FIRST DOSE 2020 -12-24Pfizer EK9231 Left arm
C4591008 -1429315648 43/F/AMERICA
N INDIAN OR
ALASKAFIRST DOSE 2020 -12-15Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-06Pfizer UNKNOWN Left arm
C4591008 -1430365248 45//
C4591008 -1432211520 40/F/WHITE FIRST DOSE 2020 -12-30Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-20Pfizer UNKNOWN Left arm
C4591008 -1432582720 35/F/WHITE FIRST DOSE 2020 -12-30Pfizer UNKNOWN Left arm
SECOND DOSE 2020 -01-20Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073803
Listing 7.7.5 Page 65of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 353of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1433021504 48// FIRST DOSE 2021 -01-22Pfizer EL9263 Left arm
SECOND DOSE 2021 -02-12Pfizer EN6201 Left arm
C4591008 -1436038720 30/UNDIFFERE
NTIATED/WHI
TEFIRST DOSE 2020 -12-29Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-19Pfizer EL3248 Right arm
C4591008 -1436436032 41// FIRST DOSE 2020 -12-18Pfizer ej1685 Left arm
C4591008 -1436662336 26/F/WHITE FIRST DOSE 2021 -01-05Pfizer EJ1685 Left arm
C4591008 -1437751872 60/F/WHITE FIRST DOSE 2020 -12-23Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-15Pfizer L21283 Right arm
C4591008 -1438329408 32/F/WHITE FIRST DOSE 2021 -01-26Moderna 010M20A Right arm
SECOND DOSE 2021 -02-24Moderna 020210A Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073804
Listing 7.7.5 Page 66of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 354of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1438522944 31//
C4591008 -1440515648 23/M/ASIAN FIRST DOSE 2021 -01-05Moderna 025J20A Left arm
SECOND DOSE 2021 -02-02Moderna 028L20A Right arm
C4591008 -1442282560 35/F/WHITE FIRST DOSE 2020 -12-28Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-19Pfizer UNKNOWN Unknown
C4591008 -1443770944 38/F/WHITE FIRST DOSE 2021 -01-08Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-18Pfizer UNKNOWN Left arm
C4591008 -1444368960 38/M/WHITE FIRST DOSE 2020 -12-23Pfizer eh9899 Left arm
SECOND DOSE 2021 -01-12Pfizer el0142 Right arm
C4591008 -1444461120 34//
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073805
Listing 7.7.5 Page 67of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 355of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1446142016 39/F/WHITE FIRST DOSE 2021 -01-21Pfizer EL3248 Right arm
SECOND DOSE 2021 -02-11Pfizer EL9261 Right arm
C4591008 -1448832576 39/F/WHITE FIRST DOSE 2020 -12-22Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-13Pfizer EL3248 Right arm
C4591008 -1450254400 41/F/WHITE FIRST DOSE 2020 -12-21Pfizer EJ1685 Right arm
C4591008 -1453017664 30/F/WHITE FIRST DOSE 2020 -12-22Pfizer E51685 Left arm
SECOND DOSE 2021 -01-13Pfizer EL0142 Left arm
C4591008 -1458266688 42/F/WHITE FIRST DOSE 2020 -12-18Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-06Pfizer EL0142 Left arm
C4591008 -1460618304 34/F/WHITE FIRST DOSE 2020 -12-21Pfizer EH9899 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073806
Listing 7.7.5 Page 68of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 356of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-11Pfizer EL1284 Left arm
C4591008 -1463369280 43/F/WHITE FIRST DOSE 2020 -12-21Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-11Pfizer EK9231 Left arm
C4591008 -1463527488 54/F/WHITE FIRST DOSE 2020 -12-16Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-05Pfizer EL1284 Left arm
C4591008 -1463739968 41/F/WHITE FIRST DOSE 2020 -12-28Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-19Pfizer UNKNOWN Left arm
C4591008 -1465095744 39//
C4591008 -1466026560 55/F/WHITE FIRST DOSE 2020 -12-29Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-19Pfizer FL3302 Right arm
C4591008 -1466239040 52// FIRST DOSE 2021 -01-21Pfizer EL1283 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073807
Listing 7.7.5 Page 69of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 357of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1467739712 39// FIRST DOSE 2020 -12-18Pfizer UNKNOWN Left arm
C4591008 -1468338240 30/F/WHITE FIRST DOSE 2020 -12-30Pfizer EK923 Left arm
SECOND DOSE 2020 -01-20Pfizer 2021 -01-20 EL3249 Left arm
2021 -01-20Pfizer EL3249 Left arm
C4591008 -1468357184 30//
C4591008 -1470768704 32/F/WHITE FIRST DOSE 2020 -12-23Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-13Pfizer EL1283 Left arm
C4591008 -1470849600 31/F/WHITE FIRST DOSE 2021 -01-02Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-23Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073808
Listing 7.7.5 Page 70of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 358of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1471406656 52/M/WHITE FIRST DOSE 2020 -12-28Pfizer Ek9231 Left arm
SECOND DOSE 2021 -01-20Pfizer UNKNOWN Left arm
C4591008 -1471433280 63/F/WHITE FIRST DOSE 2020 -12-29Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-19Pfizer el3247 Right arm
C4591008 -1471446592 35/F/WHITE FIRST DOSE 2020 -12-21Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-11Pfizer EL1284 Left arm
C4591008 -1473731648 35//
C4591008 -1475020864 33/F/WHITE FIRST DOSE 2020 -12-18Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -1475247168 54/M/WHITE FIRST DOSE 2021 -01-22Pfizer el3247 Left arm
SECOND DOSE 2021 -02-12Pfizer El3247 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073809
Listing 7.7.5 Page 71of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 359of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1475905088 58/F/WHITE FIRST DOSE 2021 -02-05Moderna 042L20A Left arm
SECOND DOSE 2021 -03-08Moderna 030M20A Left arm
C4591008 -1476814912 23/F/ASIAN FIRST DOSE 2020 -12-31Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-28Moderna 028L20A Left arm
C4591008 -1480044096 53/F/WHITE FIRST DOSE 2020 -12-17Pfizer EH9899 Right arm
SECOND DOSE 2021 -01-04Pfizer EH9899 Right arm
C4591008 -1481412160 52/F/WHITE FIRST DOSE 2020 -12-20Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-10Pfizer EJ1686 Right arm
C4591008 -1481983552 53/M/WHITE FIRST DOSE 2020 -12-16Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-06Pfizer el1284 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073810
Listing 7.7.5 Page 72of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 360of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1482766400 35/F/ASIAN FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
SECOND DOSE 2020 -12-23Pfizer ELO140 Right arm
C4591008 -1484560960 38// FIRST DOSE 2020 -12-21Pfizer EK5730 Left arm
C4591008 -1489131584 32/F/ASIAN FIRST DOSE 2020 -12-18Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-09Pfizer EL1283 Left arm
C4591008 -1489862208 47/F/ASIAN FIRST DOSE 2020 -12-28Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-19Pfizer EL 3248 Right arm
C4591008 -1490859072 32// FIRST DOSE 2020 -12-21Pfizer EJ1685 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073811
Listing 7.7.5 Page 73of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 361of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1491257408 56/F/WHITE FIRST DOSE 2020 -12-31Pfizer EL1284 Right arm
SECOND DOSE 2021 -01-22Pfizer EL3302 Right arm
C4591008 -1491283520 46// SECOND DOSE 2021 -01-11Pfizer EL3249 Left arm
C4591008 -1492121664 48/F/WHITE FIRST DOSE 2020 -12-23Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-22Moderna UNKNOWN Left arm
C4591008 -1492704832 36/F/WHITE FIRST DOSE 2021 -01-07Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -03-01Pfizer UNKNOWN Left arm
C4591008 -1493144640 57/F/WHITE FIRST DOSE 2020 -12-23Moderna 025J20 -2A Left arm
SECOND DOSE 2021 -01-20Moderna 042L20A Left arm
C4591008 -1493555776 45/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -01-21Pfizer EL3247 Right arm
SECOND DOSE 2021 -02-11Pfizer EM9810 Right arm
C4591008 -1494113856 31/M/WHITE FIRST DOSE 2020 -12-28Moderna 039k20a Left arm
SECOND DOSE 2021 -01-26Moderna 029k20a Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073812
Listing 7.7.5 Page 74of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 362of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1494998080 27//
C4591008 -1495589440 43/F/WHITE FIRST DOSE 2020 -12-20Pfizer Eh9899 Left arm
SECOND DOSE 2021 -01-11Pfizer El1283 Left arm
C4591008 -1497143872 52/F/WHITE FIRST DOSE 2020 -12-26Moderna 039K20 -2A Left arm
C4591008 -1497303104 36/F/WHITE FIRST DOSE 2020 -12-31Moderna 026L20A Right arm
SECOND DOSE 2021 -01-28Moderna 004M20A Left arm
C4591008 -1498683968 34/M/WHITE FIRST DOSE 2021 -01-22Pfizer EL3247 Right arm
UNKNOWN Right arm
SECOND DOSE 2021 -02-12Pfizer En6201 Right arm
C4591008 -1499162176 40/F/WHITE FIRST DOSE 2021 -01-12Pfizer EL1284 Left arm
SECOND DOSE 2021 -02-02Pfizer EL9261 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073813
Listing 7.7.5 Page 75of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 363of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1500052544 53// FIRST DOSE 2020 -12-23Moderna 011J20A Left arm
SECOND DOSE 2021 -01-20Moderna 013L20A Left arm
C4591008 -1501646912 56/M/WHITE FIRST DOSE 2020 -12-22Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-14Pfizer EK9251 Right arm
C4591008 -1501939776 68/F/WHITE FIRST DOSE 2020 -12-21Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-11Pfizer EK9231 Left arm
C4591008 -1502219328 42/F/WHITE FIRST DOSE 2021 -01-06Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-28Pfizer EL3249 Left arm
UNKNOWN Left arm
C4591008 -1507493440 31//
C4591008 -1509194816 35// FIRST DOSE 2020 -12-26Moderna UNKNOWN Right arm
C4591008 -1511573056 54/M/WHITE FIRST DOSE 2020 -12-29Pfizer EK9231 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073814
Listing 7.7.5 Page 76of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 364of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-18Pfizer UNKNOWN Right arm
C4591008 -1512383040 73/M/WHITE FIRST DOSE 2020 -12-15Pfizer UNKNOWN Left arm
SECOND DOSE 2020 -01-08Pfizer Don't know Left arm
C4591008 -1512621632 46/F/WHITE FIRST DOSE 2020 -12-30Moderna 039k20a Left arm
SECOND DOSE 2021 -01-27Moderna 030L20A Left arm
C4591008 -1513605184 42//
C4591008 -1513977408 20// FIRST DOSE 2020 -12-19Pfizer UNKNOWN Right arm
C4591008 -1515027008 36/M/WHITE FIRST DOSE 2020 -12-17Pfizer H9999 Left arm
SECOND DOSE 2021 -01-07Pfizer EL1284 Left arm
C4591008 -1515664960 61/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073815
Listing 7.7.5 Page 77of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 365of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2020 -01-15Pfizer UNKNOWN Left arm
C4591008 -1516435520 64/F/WHITE FIRST DOSE 2020 -12-29Moderna 026L20A Right arm
SECOND DOSE 2021 -01-26Moderna 030L20A Right arm
C4591008 -1519889984 65/F/WHITE FIRST DOSE 2020 -12-15Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-07Pfizer EL3246 Left arm
UNKNOWN Left arm
C4591008 -1520302656 30/F/WHITE FIRST DOSE 2020 -12-22Pfizer ELO140 Left arm
SECOND DOSE 2021 -01-11Pfizer el0140 Right arm
2021 -01-12Pfizer 2021 -01-11 ELO140 Right arm
C4591008 -1520607296 54/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-13Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073816
Listing 7.7.5 Page 78of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 366of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1524367936 30/F/WHITE FIRST DOSE 2020 -12-31Pfizer EL1284 Left arm
SECOND DOSE 2021 -01-21Pfizer UNKNOWN Left arm
C4591008 -1524832832 52/M/AMERIC
AN INDIAN OR
ALASKAFIRST DOSE 2021 -01-22Pfizer EL8982 Left arm
SECOND DOSE 2021 -02-25Pfizer EL9269 Left arm
C4591008 -1525098560 37/M/WHITE FIRST DOSE 2021 -01-16Moderna 041220A Left arm
SECOND DOSE 2021 -02-13Moderna 030L20A Left arm
C4591008 -1527356992 21//
C4591008 -1529124416 66/M/WHITE FIRST DOSE 2020 -11-27Pfizer EK3291 Left arm
SECOND DOSE 2021 -01-17Pfizer UNKNOWN Left arm
C4591008 -1529695808 63/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -01-13Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-11Moderna UNKNOWN Left arm
C4591008 -1529961024 24// FIRST DOSE 2021 -02-06Moderna 030M2A Left arm
C4591008 -1530333760 62/M/WHITE FIRST DOSE 2021 -01-21Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073817
Listing 7.7.5 Page 79of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 367of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-18Pfizer UNKNOWN Left arm
C4591008 -1530492480 25/M/MULTIPL
EFIRST DOSE 2021 -02-24Moderna 1A21A Left arm
SECOND DOSE 2021 -03-25Moderna UNKNOWN Left arm
C4591008 -1531143232 59/F/WHITE FIRST DOSE 2020 -12-18Pfizer EJ1695 Left arm
SECOND DOSE 2021 -01-21Pfizer EL3249 Left arm
C4591008 -1533721152 34/F/WHITE FIRST DOSE 2020 -12-23Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-13Pfizer ER 9231 Right arm
C4591008 -1535721024 53//
C4591008 -1536764480 65/F/WHITE FIRST DOSE 2020 -12-29Pfizer E11685 Left arm
SECOND DOSE 2021 -01-22Pfizer EL3248 Left arm
C4591008 -1539448384 27// FIRST DOSE 2020 -12-21Pfizer UNKNOWN Left arm
C4591008 -1540443712 58/F/WHITE FIRST DOSE 2020 -12-19Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-09Pfizer EL 3302 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073818
Listing 7.7.5 Page 80of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 368of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1541812288 40/F/WHITE FIRST DOSE 2021 -01-10Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-19Pfizer EL3302 Right arm
C4591008 -1541973056 54/F/ASIAN FIRST DOSE 2021 -01-05Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-25Pfizer EL3302 Right arm
C4591008 -1544045120 42/F/WHITE FIRST DOSE 2020 -12-21Pfizer EK5730 Left arm
C4591008 -1546862656 47/M/WHITE FIRST DOSE 2020 -12-18Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -1548522048 38// FIRST DOSE 2020 -12-20Pfizer UNKNOWN Left arm
C4591008 -1548668992 37/F/WHITE FIRST DOSE 2021 -01-04Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-24Pfizer EL3302 Left arm
C4591008 -1548881984 53/M/WHITE FIRST DOSE 2020 -12-30Pfizer EL1284 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073819
Listing 7.7.5 Page 81of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 369of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-20Pfizer EJ1686 Right arm
C4591008 -1549053504 34/F/WHITE FIRST DOSE 2020 -12-16Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-07Pfizer EL1284 Left arm
C4591008 -1550395456 59/F/WHITE FIRST DOSE 2020 -12-24Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-16Pfizer UNKNOWN Left arm
C4591008 -1550476352 51/F/WHITE SECOND DOSE 2021 -02-12Pfizer en6201 Right arm
C4591008 -1551393344 61/F/WHITE FIRST DOSE 2020 -12-18Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-11Pfizer EL1248 Left arm
C4591008 -1551990336 41/F/WHITE FIRST DOSE 2021 -01-12Moderna 025L20A Left arm
SECOND DOSE 2021 -02-09Moderna 057G20A Left arm
C4591008 -1552010304 47/F/WHITE FIRST DOSE 2021 -01-20Pfizer EL3249 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073820
Listing 7.7.5 Page 82of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 370of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-13Pfizer EN6200 Left arm
C4591008 -1553079360 48/M/WHITE FIRST DOSE 2021 -01-05Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-02Moderna UNKNOWN Left arm
C4591008 -1553451584 23/F/WHITE FIRST DOSE 2021 -01-27Moderna 004M20A Left arm
SECOND DOSE 2021 -02-24Moderna 007M20A Left arm
C4591008 -1554899520 42/F/WHITE FIRST DOSE 2020 -12-19Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-09Pfizer UNKNOWN Right arm
C4591008 -1556747840 59/M/WHITE FIRST DOSE 2020 -12-30Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-20Pfizer EL1283 Left arm
C4591008 -1556826176 36/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073821
Listing 7.7.5 Page 83of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 371of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-05Pfizer UNKNOWN Right arm
C4591008 -1558421568 54/F/WHITE FIRST DOSE 2020 -12-18Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-08Pfizer EK9231 Right arm
C4591008 -1558699584 35/M/WHITE FIRST DOSE 2021 -01-02Pfizer ELO142 Left arm
C4591008 -1558793280 25//
C4591008 -1559471680 36/M/WHITE FIRST DOSE 2020 -12-19Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
C4591008 -1560534592 41//
C4591008 -1561144896 43/F/WHITE FIRST DOSE 2020 -12-29Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-19Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073822
Listing 7.7.5 Page 84of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 372of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1561583168 29/M/ASIAN FIRST DOSE 2020 -12-17Pfizer ER5730 Left arm
SECOND DOSE 2021 -01-05Pfizer EL1284 Left arm
C4591008 -1562167360 36/M/WHITE FIRST DOSE 2020 -12-29Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-18Pfizer UNKNOWN Left arm
C4591008 -1563111488 48/F/WHITE FIRST DOSE 2020 -12-31Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-24Moderna 2021 -01-27 012L20A Left arm
2021 -01-27Moderna UNKNOWN Left arm
C4591008 -1563603008 38/F/WHITE FIRST DOSE 2021 -01-13Moderna 039K20A Left arm
SECOND DOSE 2021 -02-12Moderna 029K20A Left arm
C4591008 -1564905024 31/F/WHITE FIRST DOSE 2020 -12-30Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073823
Listing 7.7.5 Page 85of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 373of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-20Pfizer UNKNOWN Left arm
C4591008 -1565436480 34/F/WHITE FIRST DOSE 2021 -01-06Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-03Moderna UNKNOWN Left arm
C4591008 -1573110336 38/F/WHITE FIRST DOSE 2021 -01-20Moderna 011L20A Left arm
SECOND DOSE 2021 -02-17Moderna 032L20A Left arm
C4591008 -1574524480 54/F/WHITE FIRST DOSE 2020 -12-18Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-12Pfizer EL0142 Left arm
C4591008 -1575029312 55/F/WHITE FIRST DOSE 2020 -12-29Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-15Pfizer UNKNOWN Left arm
C4591008 -1575029824 42/F/WHITE FIRST DOSE 2020 -12-24Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Left arm
C4591008 -1575587904 57/F/WHITE FIRST DOSE 2020 -12-22Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073824
Listing 7.7.5 Page 86of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 374of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1575945792 42// FIRST DOSE 2020 -12-18Pfizer EL0140 Left arm
C4591008 -1577023040 47/M/WHITE FIRST DOSE 2021 -01-04Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-25Pfizer UNKNOWN Left arm
C4591008 -1577700416 36/M/WHITE FIRST DOSE 2020 -12-16Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-08Pfizer EJ1686 Left arm
C4591008 -1578391104 49/F/WHITE FIRST DOSE 2020 -12-16Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-08Pfizer EL3246 Left arm
C4591008 -1579441216 33/M/ASIAN FIRST DOSE 2021 -01-23Moderna UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073825
Listing 7.7.5 Page 87of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 375of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-20Moderna UNKNOWN Left arm
C4591008 -1579560512 37/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -1580237376 46/F/WHITE FIRST DOSE 2020 -12-30Pfizer Ek9231 Right arm
SECOND DOSE 2021 -01-20Pfizer EL3247 Right arm
C4591008 -1582191168 59// FIRST DOSE 2020 -12-16Pfizer UNKNOWN Left arm
SECOND DOSE 2020 -01-07Pfizer UNKNOWN Left arm
C4591008 -1585752128 66/F/WHITE FIRST DOSE 2021 -01-05Pfizer EL32116 Right arm
SECOND DOSE 2021 -01-26Pfizer EL8982 Right arm
C4591008 -1587784768 49//
C4591008 -1589365824 27/M/WHITE FIRST DOSE 2020 -12-23Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-13Pfizer EL3302 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073826
Listing 7.7.5 Page 88of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 376of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1589485632 40/F/WHITE FIRST DOSE 2021 -01-21Pfizer UNKNOWN Left arm
C4591008 -1592035904 38/F/WHITE FIRST DOSE 2021 -01-04Pfizer EL0142 Left arm
SECOND DOSE 2021 -01-25Pfizer EL8982 Left arm
C4591008 -1595292224 36/M/WHITE FIRST DOSE 2020 -12-19Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-09Pfizer EK9231 Left arm
C4591008 -1595464768 25//
C4591008 -1597769792 26/F/WHITE FIRST DOSE 2021 -01-31Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-28Moderna UNKNOWN Left arm
C4591008 -1598134848 28/F/WHITE FIRST DOSE 2020 -12-16Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-06Pfizer EL1284 Left arm
C4591008 -1600593472 32//
C4591008 -1600844864 35/F/WHITE FIRST DOSE 2021 -01-02Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-23Pfizer UNKNOWN Left arm
C4591008 -1602678848 53/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073827
Listing 7.7.5 Page 89of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 377of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-14Pfizer EL3249 Right arm
C4591008 -1603118144 32//
C4591008 -1603343936 37/F/WHITE FIRST DOSE 2020 -12-29Pfizer EL0140 Right arm
SECOND DOSE 2021 -01-19Pfizer EL3302 Left arm
C4591008 -1603794496 35/F/WHITE FIRST DOSE 2020 -12-18Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-08Pfizer EJ1686 Left arm
C4591008 -1604419648 20//
C4591008 -1606053952 31/F/WHITE FIRST DOSE 2020 -12-30Pfizer EH9899 Right arm
SECOND DOSE 2021 -01-20Pfizer EL3248 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073828
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BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 378of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1606664768 48/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-04Pfizer UNKNOWN Left arm
C4591008 -1609216576 39/F/WHITE FIRST DOSE 2020 -12-23Pfizer 1685 Left arm
SECOND DOSE 2021 -01-13Pfizer EK4176 Left arm
C4591008 -1611435584 59/M/WHITE FIRST DOSE 2020 -12-17Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-07Pfizer EK9231 Left arm
C4591008 -1615102016 47//
C4591008 -1615739456 33/F/WHITE FIRST DOSE 2021 -01-13Pfizer EL3246 Left arm
SECOND DOSE 2021 -02-03Pfizer EL8982 Left arm
C4591008 -1615792704 46/F/WHITE FIRST DOSE 2020 -12-25Pfizer EJ1685 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073829
Listing 7.7.5 Page 91of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 379of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-15Pfizer EL1283 Left arm
C4591008 -1615912000 44/F/WHITE FIRST DOSE 2020 -12-28Pfizer EK9231 Right arm
SECOND DOSE 2021 -01-17Pfizer EL3247 Left arm
C4591008 -1615979584 29//
C4591008 -1617041984 26//
C4591008 -1619287104 36/M/WHITE FIRST DOSE 2020 -12-29Pfizer EK9231 Right arm
SECOND DOSE 2021 -01-23Pfizer UNKNOWN Right arm
C4591008 -1621200448 47// FIRST DOSE 2021 -01-05Pfizer Fj1685 Right arm
C4591008 -1623247424 26/F/WHITE FIRST DOSE 2020 -12-21Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Right arm
C4591008 -1626741312 56/F/WHITE FIRST DOSE 2020 -12-30Moderna 026L20A Right arm
SECOND DOSE 2021 -01-26Moderna UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073830
Listing 7.7.5 Page 92of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 380of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1627007040 43/F/WHITE FIRST DOSE 2021 -01-13Moderna 039k20a Left arm
SECOND DOSE 2021 -02-11Moderna 028L20A Left arm
C4591008 -1627432000 39/F/ASIAN FIRST DOSE 2020 -12-26Pfizer E51685 Left arm
SECOND DOSE 2021 -01-16Pfizer EL3247 Left arm
C4591008 -1628508224 47/F/WHITE FIRST DOSE 2020 -12-19Pfizer EJ1685 Right arm
SECOND DOSE 2021 -01-09Pfizer EL3302 Right arm
C4591008 -1630022208 34// FIRST DOSE 2020 -12-15Moderna UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073831
Listing 7.7.5 Page 93of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 381of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1630820416 32/F/WHITE FIRST DOSE 2021 -01-07Pfizer EL1283 Right arm
SECOND DOSE 2021 -01-27Pfizer EL3247 Left arm
UNKNOWN Left arm
C4591008 -1631644224 48//
C4591008 -1633689664 47/F/WHITE FIRST DOSE 2021 -01-14Moderna 025L20A Left arm
SECOND DOSE 2021 -02-11Moderna UNKNOWN Right arm
C4591008 -1638459968 31/F/WHITE FIRST DOSE 2020 -12-19Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-07Pfizer EK9231 Left arm
C4591008 -1638938176 34/F/WHITE FIRST DOSE 2020 -12-19Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-09Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073832
Listing 7.7.5 Page 94of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 382of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1640214592 42/F/WHITE FIRST DOSE 2020 -12-24Moderna 039K20A Left arm
SECOND DOSE 2020 -01-26Moderna 2021 -01-19 027L20A Right arm
2021 -01-19Moderna 027L20A Right arm
C4591008 -1642206784 50/F/WHITE FIRST DOSE 2021 -01-19Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-12Pfizer UNKNOWN Right arm
C4591008 -1642996800 24//
C4591008 -1643043904 46/F/WHITE FIRST DOSE 2020 -12-27Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-27Pfizer UNKNOWN Left arm
C4591008 -1645515328 56/M/WHITE FIRST DOSE 2020 -12-19Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-10Pfizer EL1284 Left arm
el1284 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073833
Listing 7.7.5 Page 95of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 383of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1646259264 27/F/WHITE FIRST DOSE 2020 -12-17Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-04Pfizer EK9231 Left arm
C4591008 -1647721536 28/F/WHITE FIRST DOSE 2020 -12-30Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-21Pfizer UNKNOWN Left arm
C4591008 -1648517696 25/F/WHITE FIRST DOSE 2021 -01-01Moderna 011L20A Left arm
SECOND DOSE 2021 -01-30Moderna 028L20A Right arm
C4591008 -1648610368 34/M/BLACK
OR AFRICAN
AMERICANFIRST DOSE 1987 -02-11Pfizer 2021 -01-06 EK9231 Left arm
2021 -01-06Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-27Pfizer UNKNOWN Left arm
C4591008 -1649581120 37/M/UNKNO
WNFIRST DOSE 2020 -12-31Pfizer EK9231 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073834
Listing 7.7.5 Page 96of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 384of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-21Pfizer UNKNOWN Right arm
C4591008 -1653261376 52//
C4591008 -1655692864 37/F/WHITE FIRST DOSE 2020 -12-31Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-25Pfizer UNKNOWN Left arm
C4591008 -1655812672 65/F/WHITE FIRST DOSE 2020 -12-20Pfizer ej1685 Left arm
SECOND DOSE 2021 -01-10Pfizer EL3302 Left arm
C4591008 -1657712704 34// FIRST DOSE 2020 -12-18Pfizer Ek5730 Right arm
SECOND DOSE 2021 -01-28Pfizer UNKNOWN Left arm
C4591008 -1659598400 58/M/WHITE FIRST DOSE 2020 -12-15Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-04Pfizer UNKNOWN Left arm
C4591008 -1662150720 48/F/NOT
REPORTEDFIRST DOSE 2020 -12-22Moderna 011J20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073835
Listing 7.7.5 Page 97of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 385of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-19Moderna 027L20A Left arm
C4591008 -1663032896 40/F/WHITE FIRST DOSE 2021 -02-21Moderna 041L20A Left arm
SECOND DOSE 2021 -03-26Moderna 046A21A Left arm
C4591008 -1663877184 39/F/WHITE FIRST DOSE 2020 -12-21Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Right arm
C4591008 -1664734784 32/M/WHITE FIRST DOSE 2021 -01-20Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-17Moderna UNKNOWN Left arm
C4591008 -1669112896 55/F/WHITE FIRST DOSE 2020 -12-17Pfizer PF12 EK-
5730Left arm
SECOND DOSE 2021 -01-07Pfizer El1284 Left arm
C4591008 -1669750336 30//
C4591008 -1669896768 49/F/WHITE FIRST DOSE 2021 -01-20Moderna 013L20A Left arm
SECOND DOSE 2021 -02-17Moderna 016m20a Left arm
C4591008 -1670792256 50/M/WHITE FIRST DOSE 2021 -02-06Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073836
Listing 7.7.5 Page 98of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 386of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-27Pfizer UNKNOWN Right arm
C4591008 -1671051840 55/M/WHITE FIRST DOSE 2020 -12-23Pfizer hek9231 Left arm
SECOND DOSE 2021 -01-14Pfizer UNKNOWN Left arm
C4591008 -1678559296 41/M/WHITE FIRST DOSE 2020 -12-21Pfizer Ej168j Right arm
SECOND DOSE 2021 -01-11Pfizer EL2346 Right arm
C4591008 -1683648576 34/F/WHITE FIRST DOSE 2020 -12-28Moderna 026L20A Left arm
SECOND DOSE 2021 -01-28Moderna 032L20A Left arm
C4591008 -1685348416 33// FIRST DOSE 2021 -01-03Pfizer EJ1685 Left arm
C4591008 -1686278720 39/F/WHITE FIRST DOSE 2020 -12-21Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-18Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073837
Listing 7.7.5 Page 99of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 387of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1686451264 37/F/ASIAN FIRST DOSE 2020 -12-29Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-18Pfizer UNKNOWN Right arm
C4591008 -1686663232 55/F/WHITE FIRST DOSE 2020 -12-18Pfizer EK 5730 Left arm
SECOND DOSE 2021 -01-11Pfizer EL3248 Left arm
C4591008 -1688550464 29/F/WHITE FIRST DOSE 2021 -01-12Pfizer EL32484121 Left arm
SECOND DOSE 2021 -02-03Pfizer EL9262 Left arm
C4591008 -1688775744 40//
C4591008 -1689202240 54/F/WHITE FIRST DOSE 2020 -12-28Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-17Pfizer EL3247 Left arm
C4591008 -1689600064 51/M/WHITE FIRST DOSE 2020 -12-21Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-11Pfizer EL3248 Left arm
C4591008 -1689786944 49// FIRST DOSE 2020 -12-16Pfizer UNKNOWN Right arm
C4591008 -1690689088 61/M/WHITE FIRST DOSE 2020 -12-16Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-06Pfizer UNKNOWN Left arm
C4591008 -1692537408 48/F/WHITE FIRST DOSE 2021 -01-05Moderna 011l20a Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073838
Listing 7.7.5 Page 100of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 388of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-02Moderna 031L20A Left arm
031l20a Left arm
C4591008 -1692682304 63/F/WHITE FIRST DOSE 2021 -01-04Pfizer El0142 Right arm
SECOND DOSE 2021 -01-25Pfizer UNKNOWN Left arm
C4591008 -1693373504 35/F/WHITE FIRST DOSE 2020 -12-24Moderna 037K20A Left arm
SECOND DOSE 2021 -01-22Moderna 0432L0A Left arm
043L20A Left arm
C4591008 -1693426240 62/F/WHITE FIRST DOSE 2020 -12-31Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-21Pfizer EL3247 Left arm
C4591008 -1695578688 53//
C4591008 -1696722496 61/F/WHITE FIRST DOSE 2020 -12-22Moderna 039K20A Left arm
SECOND DOSE 2021 -01-22Moderna 012L20A Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073839
Listing 7.7.5 Page 101of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 389of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1698303552 40/F/WHITE FIRST DOSE 2021 -01-15Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-05Pfizer UNKNOWN Left arm
C4591008 -1698941504 58/F/WHITE FIRST DOSE 2021 -01-22Pfizer EL3247 Left arm
SECOND DOSE 2021 -02-10Pfizer EM9809 Left arm
C4591008 -1701332032 51/M/WHITE FIRST DOSE 2021 -01-04Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-26Pfizer EL1284 Left arm
C4591008 -1701890112 24/F/WHITE FIRST DOSE 2021 -01-23Moderna 012L20A Left arm
SECOND DOSE 2021 -02-24Moderna 031L20A Left arm
C4591008 -1702555200 50/F/WHITE FIRST DOSE 2020 -12-30Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-20Pfizer EL3246 Right arm
UNKNOWN Right arm
C4591008 -1703325760 39/M/WHITE FIRST DOSE 2021 -02-12Moderna 024M20A Left arm
SECOND DOSE 2021 -03-15Moderna UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073840
Listing 7.7.5 Page 102of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 390of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1704800832 42/F/WHITE FIRST DOSE 2020 -12-29Pfizer Ek9231 Right arm
SECOND DOSE 2020 -01-17Pfizer EL3247 Right arm
C4591008 -1707218496 63/M/WHITE FIRST DOSE 2020 -12-20Pfizer fh9844 Left arm
SECOND DOSE 2021 -01-07Pfizer EL1283 Left arm
C4591008 -1707443776 33/M/WHITE FIRST DOSE 2020 -12-19Pfizer EJ1685 Arm (side
unknown)
SECOND DOSE 2021 -01-09Pfizer EL0140 Left arm
C4591008 -1708905536 59/F/WHITE FIRST DOSE 2021 -01-07Moderna 026L20A Left arm
SECOND DOSE 2021 -02-05Moderna 031L20A Left arm
C4591008 -1710261312 58/F/WHITE FIRST DOSE 2021 -01-07Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-29Pfizer EL9264 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073841
Listing 7.7.5 Page 103of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 391of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1711403072 38/F/WHITE FIRST DOSE 2021 -01-15Pfizer el1283 Right arm
SECOND DOSE 2021 -02-05Pfizer UNKNOWN Right arm
C4591008 -1712186944 76/F/WHITE FIRST DOSE 2020 -12-30Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-26Moderna UNKNOWN Right arm
C4591008 -1716506176 41/F/WHITE FIRST DOSE 2020 -12-24Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-14Pfizer UNKNOWN Right arm
C4591008 -1720849984 58//
C4591008 -1721182272 50/F/WHITE FIRST DOSE 2020 -12-28Pfizer EH9899 Right arm
SECOND DOSE 2021 -01-18Pfizer EL3246 Left arm
C4591008 -1722989632 47/M/ASIAN FIRST DOSE 2020 -12-22Pfizer ek5730 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073842
Listing 7.7.5 Page 104of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 392of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1724875840 46/F/WHITE FIRST DOSE 2020 -12-29Moderna UNKNOWN Right arm
SECOND DOSE 2021 -01-26Moderna UNKNOWN Right arm
C4591008 -1725872704 47/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-19Pfizer 2021 -02-10 UNKNOWN Right arm
2021 -02-10Pfizer UNKNOWN Right arm
C4591008 -1726125632 33/M/AMERIC
AN INDIAN OR
ALASKAFIRST DOSE 2020 -12-19Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-09Pfizer EL1284 Right arm
C4591008 -1729181760 40/M/WHITE FIRST DOSE 2020 -12-21Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-12Pfizer EL3246 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073843
Listing 7.7.5 Page 105of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 393of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1733539904 42/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-14Pfizer UNKNOWN Left arm
C4591008 -1733884992 35//
C4591008 -1736967744 35/F/WHITE FIRST DOSE 2020 -12-26Moderna UNKNOWN Right arm
SECOND DOSE 2021 -01-26Moderna UNKNOWN Right arm
C4591008 -1737778240 45/F/WHITE FIRST DOSE 2020 -12-18Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-08Pfizer EK4176 Left arm
C4591008 -1738082880 38/F/WHITE FIRST DOSE 2020 -12-29Pfizer EK 9231 Left arm
SECOND DOSE 2021 -01-19Pfizer EL 3249 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073844
Listing 7.7.5 Page 106of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 394of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1740235328 33/F/WHITE FIRST DOSE 2021 -01-07Moderna UNKNOWN Right arm
SECOND DOSE 2021 -02-04Moderna 028L20A Right arm
C4591008 -1744261184 45/M/UNKNO
WNFIRST DOSE 2020 -12-19Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-10Pfizer UNKNOWN Left arm
C4591008 -1746240576 38/F/AMERICA
N INDIAN OR
ALASKAFIRST DOSE 2020 -12-21Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
C4591008 -1746268224 28//
C4591008 -1746347584 42/F/WHITE FIRST DOSE 2021 -01-20Moderna 037KZ0A Right arm
SECOND DOSE 2021 -02-26Moderna 042L20A Left arm
C4591008 -1747981888 43/M/ASIAN FIRST DOSE 2020 -12-24Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073845
Listing 7.7.5 Page 107of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 395of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1748127296 38/F/WHITE FIRST DOSE 2020 -12-24Pfizer Ek9231 Left arm
SECOND DOSE 2021 -01-21Pfizer UNKNOWN Right arm
C4591008 -1750359616 30/F/ASIAN FIRST DOSE 2021 -01-07Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-29Pfizer UNKNOWN Left arm
C4591008 -1750984768 45/F/WHITE FIRST DOSE 2020 -12-28Pfizer Ek9231 Left arm
SECOND DOSE 2021 -01-21Pfizer El3247 Left arm
C4591008 -1751077952 52/F/ASIAN FIRST DOSE 2020 -12-22Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-15Pfizer EL3249 Left arm
C4591008 -1751183424 33/F/NATIVE
HAWAIIAN OR
OTHERFIRST DOSE 2021 -01-14Pfizer EL 1284 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073846
Listing 7.7.5 Page 108of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 396of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-01Pfizer UNKNOWN Right arm
C4591008 -1751276096 38// SECOND DOSE 2021 -01-12Pfizer UNKNOWN Left arm
C4591008 -1758491200 36/F/WHITE FIRST DOSE 2020 -12-29Moderna 026L20A Left arm
SECOND DOSE 2021 -01-27Moderna 030L20A Right arm
C4591008 -1760151616 58/M/WHITE FIRST DOSE 2020 -12-27Pfizer EE9231 Left arm
SECOND DOSE 2021 -01-21Pfizer UNKNOWN Left arm
C4591008 -1760603712 28/F/WHITE FIRST DOSE 2020 -12-29Moderna UNKNOWN Right arm
SECOND DOSE 2021 -01-26Moderna UNKNOWN Left arm
C4591008 -1760709696 43/F/WHITE FIRST DOSE 2020 -12-23Moderna 011J20A Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073847
Listing 7.7.5 Page 109of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 397of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-20Moderna UNKNOWN Right arm
C4591008 -1764170816 49/F/WHITE FIRST DOSE 2021 -02-12Pfizer UNKNOWN Right arm
C4591008 -1765586496 31//
C4591008 -1765825600 24/F/MULTIPL
EFIRST DOSE 1997 -01-11Pfizer 2021 -01-11 EK9231 Left arm
2021 -01-11Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-31Pfizer EL3249 Left arm
C4591008 -1766329920 40/F/WHITE FIRST DOSE 2021 -01-12Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-04Pfizer UNKNOWN Left arm
C4591008 -1767180864 29/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Left arm
C4591008 -1768017472 31/M/WHITE FIRST DOSE 2020 -12-21Pfizer el0140 Left arm
SECOND DOSE 2021 -01-09Pfizer UNKNOWN Left arm
C4591008 -1770017856 50/F/WHITE FIRST DOSE 2021 -03-02Moderna 011A21A Right arm
SECOND DOSE 2021 -03-30Moderna 021B21A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073848
Listing 7.7.5 Page 110of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 398of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1771938368 24/F/WHITE FIRST DOSE 2021 -01-13Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-10Moderna UNKNOWN Left arm
C4591008 -1776190016 33/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Right arm
C4591008 -1776946752 28/F/WHITE FIRST DOSE 2020 -12-24Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-14Pfizer UNKNOWN Left arm
C4591008 -1778926656 57/F/WHITE FIRST DOSE 2021 -01-12Pfizer EL3248 Left arm
SECOND DOSE 2021 -02-02Pfizer EL9264 Left arm
C4591008 -1780267584 22/F/WHITE FIRST DOSE 2020 -12-29Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-19Pfizer EL3248 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073849
Listing 7.7.5 Page 111of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 399of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1781503552 50/F/WHITE FIRST DOSE 2021 -01-03Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-25Pfizer UNKNOWN Left arm
C4591008 -1781604416 43// FIRST DOSE 2021 -02-13Pfizer UNKNOWN Left arm
C4591008 -1782566976 44/F/WHITE FIRST DOSE 2020 -12-29Moderna 026L20A Left arm
C4591008 -1782832192 51/M/MULTIPL
EFIRST DOSE 2021 -01-10Pfizer EL1283 Right arm
SECOND DOSE 2021 -01-29Pfizer EL3247 Left arm
C4591008 -1784546368 46/M/WHITE FIRST DOSE 2020 -12-17Pfizer EH9899 Right arm
C4591008 -1787616320 22/M/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -01-16Moderna 042L20A Right arm
SECOND DOSE 2021 -02-10Moderna 024m20a Right arm
C4591008 -1788254272 36//
C4591008 -1790445632 38/F/WHITE FIRST DOSE 2020 -12-22Pfizer EJ1685 Right arm
SECOND DOSE 2021 -01-12Pfizer EL 1283 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073850
Listing 7.7.5 Page 112of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 400of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1791162944 38//
C4591008 -1791415360 36//
C4591008 -1791628352 63/F/WHITE FIRST DOSE 2021 -01-04Pfizer E129231 Left arm
SECOND DOSE 2021 -01-24Pfizer EL3427 Left arm
C4591008 -1793062976 45/M/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -01-12Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-12Pfizer UNKNOWN Left arm
C4591008 -1794697280 30/F/WHITE FIRST DOSE 2020 -12-22Pfizer EH9899 Left arm
SECOND DOSE 2020 -01-19Pfizer EK4176 Left arm
C4591008 -1796026944 62/F/WHITE FIRST DOSE 2020 -12-30Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-20Pfizer EL3248 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073851
Listing 7.7.5 Page 113of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 401of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1796637760 33/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-15Pfizer UNKNOWN Left arm
C4591008 -1796716608 39/F/WHITE FIRST DOSE 2021 -01-19Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -02-11Pfizer UNKNOWN Left arm
C4591008 -1799282240 29//
C4591008 -1799693888 30// FIRST DOSE 2020 -12-21Pfizer EJ1685 Right arm
C4591008 -1801593408 61/M/WHITE FIRST DOSE 2020 -12-28Pfizer el1284 Left arm
SECOND DOSE 2021 -01-18Pfizer ej1686 Left arm
C4591008 -1801646656 30/F/ASIAN FIRST DOSE 2021 -01-05Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-25Pfizer UNKNOWN Right arm
C4591008 -1802363456 31//
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073852
Listing 7.7.5 Page 114of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 402of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1804170816 37/M/WHITE FIRST DOSE 2020 -12-26Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-15Pfizer EL3249 Left arm
C4591008 -1804223552 69/F/ASIAN FIRST DOSE 2020 -12-30Moderna 026L20A Left arm
SECOND DOSE 2021 -01-28Moderna Do not know Left arm
C4591008 -1805420096 40/F/WHITE FIRST DOSE 2020 -12-22Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Left arm
C4591008 -1807651392 23/M/NOT
REPORTEDFIRST DOSE 2021 -01-13Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-11Moderna UNKNOWN Left arm
C4591008 -1809140288 56/F/WHITE FIRST DOSE 2021 -02-05Moderna 012M20A Left arm
SECOND DOSE 2021 -03-05Moderna 027A21A Right arm
C4591008 -1809499200 30//
C4591008 -1813418560 45/F/WHITE FIRST DOSE 2021 -01-16Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-13Moderna UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073853
Listing 7.7.5 Page 115of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 403of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1814109760 27//
C4591008 -1814421056 25/F/WHITE FIRST DOSE 2021 -03-16Moderna UNKNOWN Right arm
SECOND DOSE 2021 -04-13Moderna UNKNOWN Right arm
C4591008 -1814640704 40/F/WHITE FIRST DOSE 2021 -01-26Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -02-23Pfizer UNKNOWN Left arm
C4591008 -1814693440 25//
C4591008 -1816580672 39/F/WHITE FIRST DOSE 2020 -12-23Pfizer EL1284 Left arm
SECOND DOSE 2021 -01-15Pfizer UNKNOWN Arm (side
unknown)
C4591008 -1816661056 31/F/WHITE FIRST DOSE 2021 -01-21Pfizer EL3247 Left arm
SECOND DOSE 2021 -02-12Pfizer EN6201 Left arm
C4591008 -1817564224 34/F/WHITE FIRST DOSE 2021 -01-10Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-29Pfizer EL9264 Left arm
C4591008 -1817643072 57/F/WHITE FIRST DOSE 2021 -01-13Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -02-02Pfizer UNKNOWN Right arm
C4591008 -1819078208 24/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -01-21Moderna 026L20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073854
Listing 7.7.5 Page 116of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 404of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-26Moderna 013L20A Left arm
C4591008 -1819796032 37/F/WHITE FIRST DOSE 2020 -12-27Moderna 037K20A Right arm
SECOND DOSE 2021 -01-23Moderna 042L20A Right arm
C4591008 -1820886080 44/F/WHITE FIRST DOSE 2020 -12-19Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-09Pfizer EL3248 Right arm
C4591008 -1821357120 24/F/WHITE FIRST DOSE 2021 -03-10Moderna 024M20A Left arm
SECOND DOSE 2021 -04-07Moderna 020B21A Left arm
C4591008 -1822506048 54/F/WHITE FIRST DOSE 2021 -01-20Pfizer EL3302 Left arm
C4591008 -1824113728 37/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Left arm
SECOND DOSE 2020 -01-14Pfizer 2021 -01-14 UNKNOWN Left arm
2021 -01-14Pfizer UNKNOWN Left arm
C4591008 -1824181312 56/F/WHITE FIRST DOSE 2020 -12-18Pfizer ELO140 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073855
Listing 7.7.5 Page 117of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 405of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-08Pfizer EK9321 Left arm
C4591008 -1826041408 34/F/WHITE FIRST DOSE 2021 -02-15Pfizer EN6201 Left arm
SECOND DOSE 2021 -03-09Pfizer EN6208 Arm (side
unknown)
C4591008 -1828299328 28/M/WHITE FIRST DOSE 2021 -01-04Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-26Pfizer UNKNOWN Left arm
C4591008 -1830545472 61/F/WHITE FIRST DOSE 2020 -12-31Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-28Moderna UNKNOWN Left arm
C4591008 -1832218688 30/F/WHITE FIRST DOSE 2020 -12-18Pfizer EH9899 Right arm
SECOND DOSE 2021 -01-08Pfizer EK9231 Right arm
C4591008 -1835647040 39/F/WHITE FIRST DOSE 2021 -01-04Pfizer El1284 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073856
Listing 7.7.5 Page 118of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 406of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-26Pfizer UNKNOWN Right arm
C4591008 -1836059200 38/F/WHITE FIRST DOSE 2020 -12-29Pfizer EK9231 Right arm
SECOND DOSE 2021 -01-21Pfizer EL3302 Right arm
C4591008 -1836610624 46/F/WHITE FIRST DOSE 2021 -02-05Moderna 011M20A Right arm
SECOND DOSE . MODERNA
C4591008 -1837487680 58// FIRST DOSE 2021 -03-20Pfizer UNKNOWN Right arm
C4591008 -1838317632 49/F/WHITE FIRST DOSE 2020 -12-19Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-09Pfizer UNKNOWN Left arm
C4591008 -1838690368 38/F/WHITE FIRST DOSE 2020 -12-29Pfizer UNKNOWN Left arm
C4591008 -1839433280 55/F/WHITE FIRST DOSE 2021 -01-21Pfizer EL3248 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073857
Listing 7.7.5 Page 119of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 407of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-11Pfizer EL9266 Left arm
el9266 Left arm
C4591008 -1839513664 27/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-13Pfizer EK4176 Left arm
C4591008 -1839619136 40/F/WHITE FIRST DOSE 2021 -01-25Pfizer El3247 Left arm
SECOND DOSE 2021 -02-15Pfizer En6201 Left arm
C4591008 -1842942016 36/M/WHITE FIRST DOSE 2020 -12-28Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-21Pfizer EL3248 Left arm
C4591008 -1847431744 34/F/WHITE FIRST DOSE 2021 -01-04Pfizer ER9231 Left arm
SECOND DOSE 2021 -01-25Pfizer EL3247 Left arm
C4591008 -1847963200 73/F/WHITE FIRST DOSE 2021 -01-02Moderna UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073858
Listing 7.7.5 Page 120of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 408of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-30Moderna UNKNOWN Left arm
C4591008 -1848109632 37/M/WHITE FIRST DOSE 2020 -12-17Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-07Pfizer EL3246 Left arm
C4591008 -1850593856 43/M/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -01-13Moderna 029k20a Left arm
SECOND DOSE 2021 -02-11Moderna 028L20A Left arm
C4591008 -1851046976 37/F/WHITE FIRST DOSE 2021 -01-11Pfizer EL1283 Right arm
SECOND DOSE 2021 -01-28Pfizer EL9263 Right arm
C4591008 -1851337792 65/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -01-08Pfizer ek9231 Right arm
SECOND DOSE 2021 -01-29Pfizer el3302 Right arm
C4591008 -1851857472 31/F/WHITE FIRST DOSE 2021 -01-05Moderna 037k20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073859
Listing 7.7.5 Page 121of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 409of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-01Moderna 042L20A Left arm
C4591008 -1853039680 44/F/WHITE FIRST DOSE 2020 -12-30Pfizer EV1685 Left arm
SECOND DOSE 2021 -01-20Pfizer EL0140 Left arm
C4591008 -1853505088 27/F/WHITE FIRST DOSE 2020 -12-30Moderna 025L20A Right arm
SECOND DOSE 2021 -01-27Moderna UNKNOWN Right arm
C4591008 -1853690944 30/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-01Pfizer UNKNOWN Left arm
2021 -01-04Pfizer 2021 -01-01 UNKNOWN Left arm
C4591008 -1853770304 39/F/WHITE FIRST DOSE 2020 -12-24Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-21Moderna UNKNOWN Left arm
C4591008 -1854195776 37/F/WHITE FIRST DOSE 2020 -12-30Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-20Pfizer EL3302 Left arm
C4591008 -1856453184 48// FIRST DOSE 2020 -12-16Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073860
Listing 7.7.5 Page 122of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 410of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1856733248 61// FIRST DOSE 2020 -12-28Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-18Pfizer EK4176 Left arm
C4591008 -1856799296 34/F/WHITE FIRST DOSE 2020 -12-20Pfizer EJ1685 Right arm
SECOND DOSE 2021 -01-19Pfizer UNKNOWN Left arm
C4591008 -1857357376 40/F/WHITE FIRST DOSE 2020 -12-27Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-17Pfizer El3247 Left arm
C4591008 -1857770048 29/F/WHITE FIRST DOSE 2021 -01-22Moderna 029K20A Left arm
SECOND DOSE 2021 -02-16Moderna 031L20A Left arm
C4591008 -1860174400 66/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-15Pfizer UNKNOWN Right arm
C4591008 -1860639296 36/F/WHITE FIRST DOSE 2020 -12-28Moderna UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073861
Listing 7.7.5 Page 123of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 411of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-27Moderna UNKNOWN Left arm
C4591008 -1861383232 42/F/WHITE FIRST DOSE 2021 -01-05Moderna 025LZ0A Left arm
SECOND DOSE 2021 -02-02Moderna 032H20A Right arm
C4591008 -1862008384 32/F/WHITE FIRST DOSE 2020 -12-16Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-06Pfizer EL3246 Left arm
C4591008 -1862964800 71/F/WHITE FIRST DOSE 2020 -12-31Moderna 037K20A Right arm
SECOND DOSE 2021 -01-27Moderna UNKNOWN Right arm
C4591008 -1863522368 26// FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
C4591008 -1864000064 46/F/WHITE FIRST DOSE 2020 -12-20Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073862
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BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 412of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-13Pfizer EL1284 Left arm
C4591008 -1865820736 43/F/WHITE FIRST DOSE 2021 -01-05Pfizer EK 9231 Left arm
SECOND DOSE 2021 -01-28Pfizer EL8982 Right arm
C4591008 -1866047040 58/F/WHITE FIRST DOSE 2020 -12-27Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-17Pfizer UNKNOWN Left arm
C4591008 -1866391616 42/F/WHITE FIRST DOSE 2020 -12-20Pfizer UNKNOWN Right arm
SECOND DOSE 2020 -01-11Pfizer EL 1283 Right arm
C4591008 -1868159040 30/F/WHITE FIRST DOSE 2021 -01-08Moderna UNKNOWN Left arm
C4591008 -1869036608 34/F/WHITE FIRST DOSE 2021 -01-16Pfizer EL3248 Left arm
C4591008 -1874018368 22//
C4591008 -1874191936 39/F/WHITE FIRST DOSE 2021 -01-09Pfizer EL3246 Left arm
SECOND DOSE 2021 -02-02Pfizer EL9265 Left arm
C4591008 -1875348032 48// FIRST DOSE 2021 -01-06Moderna 077L20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073863
Listing 7.7.5 Page 125of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 413of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1875952704 22/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2021 -03-31Pfizer UNKNOWN Right arm
C4591008 -1877460032 69// FIRST DOSE 2021 -01-03Don't know UNKNOWN UNKNOWN Right arm
C4591008 -1883292224 36/F/WHITE FIRST DOSE 2020 -12-22Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-13Pfizer EL1283 Left arm
C4591008 -1888408640 45// FIRST DOSE 2020 -12-27Pfizer 9231 Left arm
C4591008 -1889976384 61//
C4591008 -1891265600 34/M/WHITE FIRST DOSE 2020 -12-16Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-07Pfizer UNKNOWN Left arm
C4591008 -1892846656 52//
C4591008 -1894320192 34/F/NOT
REPORTEDFIRST DOSE 2020 -12-22Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-15Pfizer UNKNOWN Left arm
C4591008 -1894480960 51//
C4591008 -1894958656 35/M/WHITE FIRST DOSE 2020 -12-29Moderna UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073864
Listing 7.7.5 Page 126of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 414of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-26Moderna 012M20A Right arm
C4591008 -1895489600 25/F/WHITE FIRST DOSE 2021 -01-04Pfizer EK7231 Left arm
SECOND DOSE 2021 -01-24Pfizer EL3247 Right arm
C4591008 -1896685632 43/F/WHITE FIRST DOSE 2021 -01-04Moderna UNKNOWN Right arm
SECOND DOSE 2021 -02-01Moderna UNKNOWN Right arm
Unknown Right arm
C4591008 -1896751680 53/F/ASIAN FIRST DOSE 2020 -12-29Pfizer EK9231 Right arm
SECOND DOSE 2021 -01-19Pfizer EL3247 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073865
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BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 415of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1897854528 41/M/WHITE FIRST DOSE 2021 -01-14Moderna 028L20A Left arm
SECOND DOSE 2021 -02-11Moderna 024M20A Right arm
C4591008 -1898240064 28/F/WHITE FIRST DOSE 2021 -01-06Moderna 012L20A Right arm
SECOND DOSE 2021 -02-03Moderna 012L20A Left arm
C4591008 -1899130432 41/F/WHITE FIRST DOSE 2020 -12-23Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-11Pfizer EL1284 Left arm
C4591008 -1900539456 52/F/WHITE FIRST DOSE 2020 -12-29Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-19Pfizer el3247 Left arm
C4591008 -1903488576 64//
C4591008 -1903635008 36//
C4591008 -1903688256 36/F/WHITE FIRST DOSE 2021 -01-06Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-27Pfizer EL3246 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073866
Listing 7.7.5 Page 128of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 416of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1909201472 51/M/WHITE FIRST DOSE 2020 -12-31Moderna 7006320002 Left arm
SECOND DOSE 2020 -01-28Moderna 7006320010 Left arm
C4591008 -1909401152 41/M/WHITE FIRST DOSE 2020 -12-28Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-15Pfizer UNKNOWN Left arm
C4591008 -1910079552 54/F/WHITE FIRST DOSE 2020 -12-16Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-13Pfizer UNKNOWN Right arm
C4591008 -1910451264 54//
C4591008 -1910490176 47/M/WHITE FIRST DOSE 2020 -12-17Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-07Pfizer EK5730 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073867
Listing 7.7.5 Page 129of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 417of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1910491200 32/F/WHITE FIRST DOSE 2021 -01-05Moderna 025L20A Right arm
SECOND DOSE 2021 -02-02Moderna UNKNOWN Left arm
C4591008 -1911513664 47//
C4591008 -1911712320 47//
C4591008 -1912004672 33/F/WHITE FIRST DOSE 2020 -12-19Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-09Pfizer EL1283 Left arm
Other
C4591008 -1914423872 57/M/NOT
REPORTEDFIRST DOSE 2021 -03-05Pfizer EN6206 Right arm
SECOND DOSE 2021 -03-24Pfizer er8727 Right arm
C4591008 -1914742336 57/F/WHITE FIRST DOSE 2021 -02-26Pfizer EN6203 Right arm
SECOND DOSE 2021 -03-19Pfizer EP7534 Right arm
C4591008 -1915672128 30/F/WHITE FIRST DOSE 2020 -12-27Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-18Pfizer EL3302 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073868
Listing 7.7.5 Page 130of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 418of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1915765824 57/F/ASIAN FIRST DOSE 2020 -12-23Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-14Pfizer EL1283 Left arm
C4591008 -1916164672 47/F/WHITE FIRST DOSE 2021 -01-02Moderna 011L20A Left arm
SECOND DOSE 2020 -02-03Moderna UNKNOWN Left arm
C4591008 -1916987456 32/F/WHITE FIRST DOSE 2020 -12-19Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-09Pfizer EL1283 Right arm
UNKNOWN Right arm
C4591008 -1917877312 48/F/WHITE FIRST DOSE 2021 -01-02Moderna 037K20A Arm (side
unknown)
SECOND DOSE 2021 -01-26Moderna 042L20A Arm (side
unknown)
C4591008 -1918303296 48/M/WHITE FIRST DOSE 2021 -01-05Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-26Pfizer UNKNOWN Left arm
C4591008 -1918475328 53/F/WHITE FIRST DOSE 2020 -12-16Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-06Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073869
Listing 7.7.5 Page 131of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 419of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1920163904 29//
C4591008 -1922196544 59/M/WHITE FIRST DOSE 2020 -12-15Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-05Pfizer UNKNOWN Left arm
C4591008 -1922462272 67// FIRST DOSE 2020 -12-19Pfizer UNKNOWN Right arm
C4591008 -1922475584 33/F/WHITE FIRST DOSE 2021 -01-11Pfizer EK9231 Left arm
SECOND DOSE 2021 -02-03Pfizer EL3249 Left arm
C4591008 -1922554944 27//
C4591008 -1922688064 25/F/WHITE FIRST DOSE 2021 -01-06Pfizer UNKNOWN Left arm
C4591008 -1923352128 54/F/WHITE FIRST DOSE 2020 -12-24Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-15Pfizer EL1283 Left arm
C4591008 -1926009920 49/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2020 -12-27Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-27Moderna UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073870
Listing 7.7.5 Page 132of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 420of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1926448704 66/F/WHITE FIRST DOSE 2020 -12-23Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-14Pfizer EL1283 Left arm
2021 -01-15Pfizer 2021 -01-14 UNKNOWN Left arm
C4591008 -1929092160 29// FIRST DOSE 2021 -01-05Moderna 011L20A Left arm
C4591008 -1929304128 60/F/WHITE FIRST DOSE 2021 -01-13Pfizer no idea Left arm
SECOND DOSE 2021 -02-03Pfizer unknown Left arm
C4591008 -1929836096 23/F/WHITE FIRST DOSE 2021 -01-07Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-28Pfizer EL9261 Left arm
C4591008 -1931337792 37/F/WHITE FIRST DOSE 2020 -12-16Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-06Pfizer EL 1284 Left arm
EL1284 Left arm
C4591008 -1932253760 40// FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073871
Listing 7.7.5 Page 133of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 421of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-16Pfizer UNKNOWN Right arm
C4591008 -1935044672 30/M/NOT
REPORTEDFIRST DOSE 2021 -01-13Moderna 039K20A Left arm
SECOND DOSE 2021 -02-11Moderna 028L20A Left arm
C4591008 -1935136832 48/M/WHITE FIRST DOSE 2020 -12-27Moderna UNKNOWN Right arm
SECOND DOSE 2021 -01-23Moderna 013L20A Right arm
C4591008 -1935270976 52/F/WHITE FIRST DOSE 2020 -12-21Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-19Pfizer UNKNOWN Left arm
C4591008 -1936971328 44/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073872
Listing 7.7.5 Page 134of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 422of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-08Pfizer EJ1686 Left arm
C4591008 -1937183296 47/F/WHITE FIRST DOSE 2020 -12-24Moderna 011j02a Left arm
SECOND DOSE 2021 -01-21Moderna UNKNOWN Left arm
C4591008 -1937355840 34/F/WHITE FIRST DOSE 2021 -01-15Pfizer EK9231 Left arm
SECOND DOSE 2021 -02-05Pfizer EL9269 Left arm
C4591008 -1938260032 48/F/WHITE FIRST DOSE 2020 -12-24Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-14Pfizer EL0142 Left arm
C4591008 -1938924608 30/M/WHITE FIRST DOSE 2021 -01-05Moderna 026L20A Left arm
SECOND DOSE 2021 -02-05Moderna 029L20A Left arm
C4591008 -1939003456 51/F/WHITE FIRST DOSE 2020 -12-21Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-12Pfizer EK9231 Left arm
C4591008 -1941581376 46//
C4591008 -1941634624 30/F/WHITE FIRST DOSE 2020 -12-29Moderna 011j20a Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073873
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BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 423of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-26Moderna UNKNOWN Right arm
C4591008 -1942126656 61/F/WHITE FIRST DOSE 2020 -12-15Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-05Pfizer EL0142 Left arm
UNKNOWN Left arm
C4591008 -1942511680 52/F/WHITE FIRST DOSE 2020 -12-23Pfizer EK9231 Right arm
SECOND DOSE 2021 -01-11Pfizer EK9231 Right arm
C4591008 -1943647808 54/F/WHITE FIRST DOSE 2021 -03-12Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -04-02Pfizer EP7533 Left arm
UNKNOWN Left arm
C4591008 -1943681088 25/F/ASIAN FIRST DOSE 2020 -12-30Pfizer EK9231 Right arm
SECOND DOSE 2021 -01-20Pfizer EL3247 Right arm
C4591008 -1945235520 39/F/WHITE FIRST DOSE 2021 -01-06Pfizer EL 0140 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073874
Listing 7.7.5 Page 136of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 424of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-27Pfizer EL3246 Left arm
C4591008 -1945528384 32/F/WHITE FIRST DOSE 2020 -12-27Moderna 025J20A Right arm
SECOND DOSE 2021 -01-23Moderna 028L20A Left arm
C4591008 -1946709568 48/F/WHITE FIRST DOSE 2020 -12-28Pfizer EK 9231 Left arm
SECOND DOSE 2021 -01-21Pfizer EL3248 Left arm
C4591008 -1947122240 50/F/WHITE FIRST DOSE 2020 -12-17Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-06Pfizer EK9231 Left arm
UNKNOWN Left arm
C4591008 -1948596800 56// FIRST DOSE 2021 -01-04Pfizer ek5730 Left arm
C4591008 -1951147584 32/F/WHITE FIRST DOSE 2020 -12-29Moderna 039K20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073875
Listing 7.7.5 Page 137of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 425of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-28Moderna UNKNOWN Left arm
C4591008 -1953672256 41// FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
C4591008 -1954097216 30/F/WHITE FIRST DOSE 2020 -12-29Pfizer EK9231 Left arm
SECOND DOSE 2020 -01-19Pfizer EL3302 Right arm
C4591008 -1954496576 22/F/WHITE FIRST DOSE 2020 -12-28Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-22Pfizer UNKNOWN Left arm
C4591008 -1954629184 36/F/WHITE FIRST DOSE 2020 -12-21Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-11Pfizer EK9231 Left arm
C4591008 -1954961472 39/F/WHITE FIRST DOSE 2020 -12-28Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-25Moderna 032L20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073876
Listing 7.7.5 Page 138of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 426of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1955877952 27/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Left arm
C4591008 -1956833856 28/F/WHITE FIRST DOSE 2021 -02-17Pfizer EN601 Left arm
SECOND DOSE 2021 -03-11Pfizer EN6208 Left arm
UNKNOWN Left arm
C4591008 -1958209088 65/F/WHITE FIRST DOSE 2021 -01-11Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-01Pfizer UNKNOWN Left arm
C4591008 -1958615616 41//
C4591008 -1958721088 38/F/WHITE FIRST DOSE 2021 -01-10Moderna D11L20A Left arm
SECOND DOSE 2021 -02-08Moderna UNKNOWN Left arm
C4591008 -1958868032 48/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-07Pfizer UNKNOWN Left arm
C4591008 -1960541248 35/F/WHITE FIRST DOSE 2020 -12-23Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-13Pfizer UNKNOWN Arm (side
unknown)
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073877
Listing 7.7.5 Page 139of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 427of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1963583552 41/F/UNKNOW
NFIRST DOSE 2021 -02-22Pfizer UNKNOWN Right arm
C4591008 -1964234816 40/F/WHITE FIRST DOSE 2020 -12-28Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-26Moderna 030L20A Left arm
C4591008 -1964673600 24/F/ASIAN FIRST DOSE 2020 -12-26Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-16Pfizer EL8982 Left arm
C4591008 -1964726336 64/F/WHITE FIRST DOSE 2021 -01-23Moderna 013L20A Left arm
SECOND DOSE 2021 -02-21Moderna 016M20A Left arm
C4591008 -1965883456 46/F/ASIAN FIRST DOSE 2020 -12-16Pfizer EK5760 Left arm
SECOND DOSE 2021 -01-05Pfizer EL0142 Left arm
C4591008 -1966785600 38/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073878
Listing 7.7.5 Page 140of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 428of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Left arm
C4591008 -1969816128 40/F/WHITE FIRST DOSE 2020 -12-22Pfizer EL0140 Left arm
SECOND DOSE 2020 -01-09Pfizer 2021 -01-09 Ek5730 Left arm
2021 -01-09Pfizer EK5730 Left arm
C4591008 -1970586176 36/F/WHITE FIRST DOSE 2020 -12-23Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Left arm
C4591008 -1971038272 29/F/WHITE FIRST DOSE 2020 -12-26Pfizer Ek9231 Left arm
SECOND DOSE 2020 -01-20Pfizer 2021 -01-21 UNKNOWN Left arm
2021 -01-21Pfizer UNKNOWN Left arm
C4591008 -1972870720 33/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2020 -12-31Pfizer Ek9231 Left arm
SECOND DOSE 2021 -01-21Pfizer UNKNOWN Left arm
C4591008 -1973496384 58/F/WHITE FIRST DOSE 2021 -01-07Moderna 011L20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073879
Listing 7.7.5 Page 141of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 429of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-04Moderna 031L20A Left arm
C4591008 -1973727808 67/M/WHITE FIRST DOSE 2021 -03-17Moderna UNKNOWN Left arm
SECOND DOSE 2021 -04-14Moderna UNKNOWN Left arm
C4591008 -1974226496 66// FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
C4591008 -1976126016 48/F/WHITE FIRST DOSE 2021 -01-03Pfizer EK9231 Right arm
SECOND DOSE 2021 -01-28Pfizer EN9581 Left arm
C4591008 -1976976448 35/F/WHITE FIRST DOSE 2020 -12-23Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-13Pfizer EK9231 Left arm
C4591008 -1977680960 50/F/WHITE FIRST DOSE 2020 -12-15Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-04Pfizer 2021 -01-05 EK4176 Right arm
2021 -01-05Pfizer UNKNOWN Left arm
C4591008 -1978105920 40/F/WHITE FIRST DOSE 2020 -12-15Pfizer EH9899 Left arm
C4591008 -1981933120 43/F/WHITE FIRST DOSE 2020 -12-27Pfizer EL0142 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073880
Listing 7.7.5 Page 142of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 430of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-14Pfizer EL1283 Right arm
C4591008 -1981945920 33/F/WHITE FIRST DOSE 2020 -12-24Pfizer UNKNOWN Arm (side
unknown)
SECOND DOSE 2021 -01-14Pfizer UNKNOWN Arm (side
unknown)
C4591008 -1982279232 57/M/WHITE FIRST DOSE 2020 -12-22Pfizer ek5730 Left arm
SECOND DOSE 2021 -01-11Pfizer el3246 Left arm
C4591008 -1983474752 34/F/WHITE FIRST DOSE 2020 -12-26Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-16Pfizer EL1284 Right arm
C4591008 -1983660608 40/F/WHITE FIRST DOSE 2021 -01-05Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-27Pfizer UNKNOWN Right arm
C4591008 -1984045632 29/F/WHITE FIRST DOSE 2020 -12-22Pfizer EL1284 Left arm
SECOND DOSE 2021 -01-19Pfizer EJ1686 Left arm
C4591008 -1985454144 55/F/WHITE FIRST DOSE 2020 -12-16Pfizer EH9899 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073881
Listing 7.7.5 Page 143of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 431of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-07Pfizer EH9899 Right arm
C4591008 -1987366464 34// FIRST DOSE 2020 -12-22Pfizer UNKNOWN Left arm
C4591008 -1987758656 32/F/WHITE FIRST DOSE 2021 -03-14Moderna 044A21A Left arm
SECOND DOSE 2021 -04-11Moderna 042B21A Left arm
C4591008 -1987925056 23/F/WHITE FIRST DOSE 2021 -01-04Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-01Moderna 2021 -02-12 UNKNOWN Left arm
2021 -02-12Moderna UNKNOWN Left arm
C4591008 -1988788288 36/M/WHITE FIRST DOSE 2020 -12-19Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-10Pfizer UNKNOWN Left arm
C4591008 -1989944384 45/F/WHITE FIRST DOSE 2021 -01-08Pfizer EK9231 Right arm
SECOND DOSE 2021 -02-10Pfizer EL9261 Right arm
C4591008 -1990050368 31/F/WHITE FIRST DOSE 2020 -12-23Pfizer EH9899 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073882
Listing 7.7.5 Page 144of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 432of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-15Pfizer El1283 Right arm
C4591008 -1992356928 33/F/WHITE FIRST DOSE 2021 -02-16Pfizer En6201 Left arm
SECOND DOSE 2021 -03-09Pfizer En601 Left arm
C4591008 -1992389184 34/F/ASIAN FIRST DOSE 2020 -12-23Moderna 039k20 -2a Left arm
SECOND DOSE 2021 -01-20Moderna 026l20a Right arm
C4591008 -1995199040 56/F/WHITE FIRST DOSE 2021 -01-21Moderna 037K2OA Left arm
SECOND DOSE 2021 -02-18Moderna 024M20A Left arm
C4591008 -1996495936 60/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-08Pfizer EL3302 Left arm
C4591008 -1998434368 46// SECOND DOSE 2021 -01-19Pfizer EL1283 Left arm
C4591008 -1998621248 27// FIRST DOSE 2020 -12-24Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073883
Listing 7.7.5 Page 145of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 433of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -1998833728 33//
C4591008 -1998925888 30/F/ASIAN FIRST DOSE 2020 -12-31Moderna 011L20A Left arm
SECOND DOSE 2021 -01-28Moderna 007M20A Left arm
C4591008 -2001337920 46/F/WHITE FIRST DOSE 2021 -04-08Janssen 043A21A Left arm
C4591008 -2004905024 38/M/WHITE FIRST DOSE 2020 -12-26Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-22Pfizer EL3249 Left arm
C4591008 -2006340160 40/F/WHITE FIRST DOSE 2020 -12-22Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-12Pfizer EL3249 Left arm
C4591008 -2006950976 32/F/WHITE FIRST DOSE 2020 -12-29Pfizer UNKNOWN Left arm
C4591008 -2007098432 71/M/WHITE FIRST DOSE 2020 -12-28Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073884
Listing 7.7.5 Page 146of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 434of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-19Pfizer UNKNOWN Right arm
C4591008 -2007881280 35// FIRST DOSE 2020 -12-28Pfizer El1284 Right arm
C4591008 -2008719424 60/F/WHITE FIRST DOSE 2020 -12-18Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-08Pfizer EK9231 Left arm
C4591008 -2008865344 56/F/WHITE FIRST DOSE 2021 -01-04Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-25Pfizer EL9263 Right arm
C4591008 -2010021440 38/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-07Pfizer UNKNOWN Left arm
C4591008 -2010686016 33/F/WHITE FIRST DOSE 2020 -12-24Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-14Pfizer EL3248 Left arm
C4591008 -2011017792 50/F/WHITE FIRST DOSE 2021 -01-10Moderna 025L20A Right arm
SECOND DOSE 2021 -02-03Moderna 007M20A Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073885
Listing 7.7.5 Page 147of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 435of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2011881536 29/F/WHITE FIRST DOSE 2021 -01-03Moderna 025J20A Left arm
SECOND DOSE 2021 -01-29Moderna UNKNOWN Left arm
C4591008 -2013555264 63/F/WHITE FIRST DOSE 2020 -12-17Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-07Pfizer Ek9231 Right arm
C4591008 -2013874752 57//
C4591008 -2014405184 46/F/WHITE FIRST DOSE 2020 -12-18Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-08Pfizer EK9831 Left arm
C4591008 -2014910016 49/F/WHITE FIRST DOSE 2020 -12-24Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-14Pfizer UNKNOWN Right arm
C4591008 -2016145472 40//
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073886
Listing 7.7.5 Page 148of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 436of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2016344640 43/F/WHITE FIRST DOSE 2020 -12-22Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Left arm
C4591008 -2018072128 39/M/WHITE FIRST DOSE 2020 -12-27Moderna 011J2OA Right arm
SECOND DOSE 2021 -01-23Moderna UNKNOWN Right arm
C4591008 -2019760192 29/F/WHITE FIRST DOSE 2021 -01-12Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-30Pfizer EL3249 Left arm
C4591008 -2020252224 46/F/WHITE FIRST DOSE 2020 -12-18Pfizer Ek5730 Right arm
SECOND DOSE 2021 -01-08Pfizer El0142 Left arm
C4591008 -2021606464 24// FIRST DOSE 2020 -12-21Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073887
Listing 7.7.5 Page 149of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 437of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2022616128 42/F/WHITE FIRST DOSE 2021 -01-04Pfizer UNKNOWN Left arm
SECOND DOSE 2020 -01-25Pfizer UNKNOWN Left arm
C4591008 -2022657088 63/F/WHITE FIRST DOSE 2020 -12-29Moderna 011J2OA Left arm
UNKNOWN Left arm
SECOND DOSE 2021 -01-26Moderna 029L20A Left arm
C4591008 -2022803008 25/F/WHITE FIRST DOSE 2020 -12-18Pfizer Eh9899 Left arm
SECOND DOSE 2021 -01-07Pfizer EL1283 Left arm
UNKNOWN Left arm
C4591008 -2025977920 26/F/WHITE FIRST DOSE 2020 -12-30Moderna 011J20A Right arm
SECOND DOSE 2021 -01-27Moderna 013L20A Right arm
C4591008 -2027998272 34//
C4591008 -2030509120 34/F/WHITE FIRST DOSE 2020 -12-17Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073888
Listing 7.7.5 Page 150of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 438of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2031013952 35/F/WHITE FIRST DOSE 2020 -12-30Moderna 039k20a Right arm
SECOND DOSE 2021 -01-27Moderna UNKNOWN Right arm
C4591008 -2031033408 50//
C4591008 -2033271872 40/F/WHITE FIRST DOSE 2020 -12-16Pfizer EK573 Left arm
SECOND DOSE 2021 -01-04Pfizer UNKNOWN Left arm
C4591008 -2034707008 41/M/WHITE FIRST DOSE 2020 -12-21Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-13Pfizer EL3248 Right arm
C4591008 -2036621376 42/F/WHITE FIRST DOSE 2020 -12-23Pfizer EK5730 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073889
Listing 7.7.5 Page 151of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 439of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-13Pfizer EK9231 Right arm
C4591008 -2037737024 60// FIRST DOSE 2020 -12-22Pfizer EJ1685 Right arm
C4591008 -2038586944 37/F/WHITE FIRST DOSE 2020 -12-14Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-04Pfizer UNKNOWN Right arm
C4591008 -2039225408 39/F/WHITE FIRST DOSE 2020 -12-17Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-18Pfizer UNKNOWN Right arm
C4591008 -2039397952 45/F/WHITE FIRST DOSE 2020 -12-23Moderna 039K20A Left arm
SECOND DOSE 2021 -01-21Moderna 039K20A Left arm
C4591008 -2040606784 47/F/ASIAN FIRST DOSE 2020 -12-18Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-08Pfizer EL0142 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073890
Listing 7.7.5 Page 152of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 440of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2041523264 55/F/WHITE FIRST DOSE 2021 -01-09Moderna 011l20a Left arm
SECOND DOSE 2021 -02-06Moderna 030l20a Left arm
C4591008 -2041629248 56/F/WHITE FIRST DOSE 2020 -12-29Moderna UNKNOWN Left arm
SECOND DOSE 2021 -01-27Moderna 028L20A Left arm
C4591008 -2042732608 54// FIRST DOSE 2020 -12-18Pfizer EH9899 Right arm
C4591008 -2044892224 63/F/WHITE FIRST DOSE 2021 -03-07Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -03-27Pfizer EP6955 Left arm
C4591008 -2047130688 49/F/WHITE FIRST DOSE 2020 -12-28Moderna 039K20A Left arm
SECOND DOSE 2020 -01-21Moderna 2021 -01-21 UNKNOWN Right arm
2021 -01-21Moderna 028L20A Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073891
Listing 7.7.5 Page 153of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 441of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2050690624 47/F/WHITE FIRST DOSE 2021 -01-05Moderna 026L20A Left arm
SECOND DOSE 2021 -02-03Moderna 013L20A Left arm
C4591008 -2051235904 48/F/WHITE FIRST DOSE 2020 -12-18Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-08Pfizer EL1284 Left arm
C4591008 -2053003840 26/F/WHITE FIRST DOSE 2021 -01-14Pfizer EL1283 Left arm
C4591008 -2057301568 34// FIRST DOSE 2021 -03-31Moderna 046A21A Right arm
SECOND DOSE 2021 -04-29Moderna 017C21A Right arm
C4591008 -2061241408 35// FIRST DOSE 2020 -12-30Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-21Pfizer UNKNOWN Left arm
C4591008 -2061798976 65/F/WHITE FIRST DOSE 2021 -02-05Pfizer tz3247 Left arm
C4591008 -2062716480 40/F/WHITE FIRST DOSE 2020 -12-23Pfizer EJ1685 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073892
Listing 7.7.5 Page 154of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 442of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-13Pfizer EL0142 Right arm
C4591008 -2064136768 53//
C4591008 -2064350784 35/F/WHITE FIRST DOSE 2020 -12-24Moderna 039620a Left arm
SECOND DOSE 2021 -01-20Moderna 028L20A Left arm
C4591008 -2064615488 49/F/WHITE FIRST DOSE 2020 -12-18Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -2068043328 31/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-13Pfizer UNKNOWN Right arm
C4591008 -2068070976 30/F/WHITE FIRST DOSE 2020 -12-18Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-08Pfizer EL1283 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073893
Listing 7.7.5 Page 155of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 443of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2070143040 47//
C4591008 -2070515264 42//
C4591008 -2071830592 41/F/WHITE FIRST DOSE 2021 -01-07Moderna 012l20a Right arm
SECOND DOSE 2021 -02-04Moderna 029l20a Right arm
C4591008 -2071910464 23/F/ASIAN FIRST DOSE 2020 -12-20Pfizer EL0140 Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Left arm
C4591008 -2073172544 24/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Right arm
C4591008 -2074633280 40/F/MULTIPL
EFIRST DOSE 2020 -12-15Pfizer UNKNOWN Arm (side
unknown)
SECOND DOSE 2021 -01-06Pfizer PAA156051 Left arm
C4591008 -2074634304 62/F/WHITE FIRST DOSE 2021 -01-21Pfizer EL3247 Left arm
SECOND DOSE 2021 -02-11Pfizer EM9810 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073894
Listing 7.7.5 Page 156of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 444of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2075138624 61/F/WHITE FIRST DOSE 2021 -03-05Pfizer EN6206 Left arm
SECOND DOSE 2021 -03-26Pfizer UNKNOWN Right arm
C4591008 -2076746304 48/F/WHITE FIRST DOSE 2020 -12-23Pfizer Ej1685 Left arm
SECOND DOSE 2021 -01-11Pfizer EL1283 Unknown
C4591008 -2076813376 29/F/WHITE FIRST DOSE 2021 -01-11Pfizer EL1283 Left arm
SECOND DOSE 2021 -01-29Pfizer EL3247 Left arm
C4591008 -2078666816 51/F/WHITE FIRST DOSE 2021 -04-06Janssen UNKNOWN Left arm
C4591008 -2079005248 61/F/WHITE FIRST DOSE 2020 -12-30Pfizer EL0142 Left arm
SECOND DOSE . PFIZER
C4591008 -2080678976 37/M/WHITE FIRST DOSE 2020 -12-19Pfizer EK 5730 Left arm
SECOND DOSE 2021 -01-09Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073895
Listing 7.7.5 Page 157of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 445of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2080733248 57/F/WHITE FIRST DOSE 2020 -12-27Moderna 037k20a Left arm
SECOND DOSE 2021 -01-25Moderna 042l20a Left arm
C4591008 -2082572864 64/M/WHITE FIRST DOSE 2021 -02-11Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -03-04Pfizer UNKNOWN Left arm
C4591008 -2082885696 49/M/WHITE FIRST DOSE 2020 -12-21Pfizer EH9899 Right arm
SECOND DOSE 2021 -01-11Pfizer EK9231 Right arm
C4591008 -2085230144 51/F/WHITE FIRST DOSE 2021 -01-31Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-28Moderna UNKNOWN Left arm
C4591008 -2085662272 45//
C4591008 -2085742144 33/F/ASIAN FIRST DOSE 2020 -12-24Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-15Pfizer EL1283 Left arm
C4591008 -2086419008 31/F/WHITE FIRST DOSE 2020 -12-28Pfizer EK9231 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073896
Listing 7.7.5 Page 158of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 446of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-20Pfizer UNKNOWN Left arm
C4591008 -2087708736 50/F/WHITE
C4591008 -2088611392 40/F/WHITE FIRST DOSE 2020 -12-24Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-14Pfizer EK4176 Left arm
C4591008 -2089276480 45/F/WHITE FIRST DOSE 2021 -01-20Moderna UNKNOWN Left arm
SECOND DOSE . MODERNA
C4591008 -2090232896 35/F/WHITE FIRST DOSE 2020 -12-31Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-21Pfizer EL3249 Left arm
C4591008 -2091182656 41//
C4591008 -2092371520 27/F/WHITE FIRST DOSE 2020 -12-18Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-08Pfizer EJ1686 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073897
Listing 7.7.5 Page 159of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 447of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2094298176 46/M/ASIAN FIRST DOSE 2020 -12-22Pfizer Eh9899 Left arm
SECOND DOSE 2021 -01-01Pfizer EK9231 Left arm
C4591008 -2095653952 26/F/WHITE FIRST DOSE 2021 -01-11Pfizer EL1284 Left arm
SECOND DOSE 2021 -02-01Pfizer EN5318 Right arm
C4591008 -2098164800 48/F/WHITE FIRST DOSE 2020 -12-21Pfizer EJ 1685 Left arm
SECOND DOSE 2021 -01-07Pfizer EL1284 Left arm
C4591008 -2098736192 37//
C4591008 -2100809280 36/F/WHITE FIRST DOSE 2021 -01-05Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -02-05Pfizer UNKNOWN Left arm
C4591008 -2103724608 24/F/WHITE FIRST DOSE 2021 -01-11Pfizer EK9231 Left arm
SECOND DOSE 2021 -01-28Pfizer EL3249 Left arm
C4591008 -2104044608 63/M/MULTIPL
EFIRST DOSE 2021 -02-13Moderna UNKNOWN Right arm
SECOND DOSE 2021 -03-04Moderna UNKNOWN Right arm
C4591008 -2104063552 45/F/WHITE FIRST DOSE 2020 -12-28Pfizer 13873 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073898
Listing 7.7.5 Page 160of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 448of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-15Pfizer EL3246
#14076Left arm
C4591008 -2105605696 36/F/WHITE FIRST DOSE 2020 -12-20Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-09Pfizer EL3248 Left arm
C4591008 -2108022848 56/F/WHITE FIRST DOSE 2020 -12-21Pfizer EK5730 Left arm
SECOND DOSE 2021 -01-11Pfizer EL1284 Left arm
C4591008 -2108846656 57/F/WHITE FIRST DOSE 2020 -12-22Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-08Pfizer EK9231 Left arm
C4591008 -2109989952 50/F/WHITE FIRST DOSE 2020 -12-16Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-07Pfizer UNKNOWN Right arm
C4591008 -2111304256 36/F/WHITE FIRST DOSE 2021 -01-11Moderna 7006320010 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073899
Listing 7.7.5 Page 161of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 449of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2113337920 56/M/WHITE FIRST DOSE 2021 -01-02Moderna UNKNOWN Right arm
SECOND DOSE 2021 -01-30Moderna UNKNOWN Right arm
C4591008 -2113789504 47/F/WHITE FIRST DOSE 2020 -12-16Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-06Pfizer EH9899 Left arm
C4591008 -2114241600 32/M/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-11Pfizer UNKNOWN Right arm
C4591008 -2115264064 53/F/WHITE FIRST DOSE 2021 -01-06Moderna UNKNOWN Left arm
SECOND DOSE . MODERNA
C4591008 -2116473408 38/F/WHITE FIRST DOSE 2020 -12-31Moderna 025J20A Left arm
SECOND DOSE 2021 -02-01Moderna 038K20A Left arm
C4591008 -2116673088 28/F/WHITE FIRST DOSE 2021 -01-04Moderna 039K20A Left arm
SECOND DOSE 2021 -02-02Moderna 004M20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073900
Listing 7.7.5 Page 162of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 450of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2117975616 25/F/WHITE FIRST DOSE 2021 -01-05Moderna 026L20A Left arm
SECOND DOSE 2021 -02-08Moderna 031L20A Left arm
C4591008 -2118014016 64/M/WHITE FIRST DOSE 2020 -12-22Pfizer EL1284 Left arm
SECOND DOSE 2021 -01-11Pfizer ER9231 Left arm
C4591008 -2118453824 46/F/WHITE FIRST DOSE 2021 -01-06Pfizer EL1284 Right arm
SECOND DOSE 2021 -01-26Pfizer EL9262 Right arm
C4591008 -2118493248 38/F/WHITE FIRST DOSE 2020 -12-24Moderna 0391K20 -2A Left arm
SECOND DOSE 2021 -01-20Moderna 013L20A Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073901
Listing 7.7.5 Page 163of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 451of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2118958656 49/F/WHITE FIRST DOSE 2021 -01-05Pfizer ek5730 Right arm
SECOND DOSE 2021 -01-26Pfizer UNKNOWN Right arm
C4591008 -2119264320 34/F/WHITE FIRST DOSE 2020 -12-15Pfizer Eks730 Left arm
SECOND DOSE 2021 -01-05Pfizer EK5730 Left arm
C4591008 -2120764480 42/F/ASIAN FIRST DOSE 2021 -01-06Pfizer EL3246 Left arm
SECOND DOSE 2021 -01-27Pfizer UNKNOWN Left arm
C4591008 -2121017408 53/F/BLACK
OR AFRICAN
AMERICANFIRST DOSE 2020 -12-20Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-10Pfizer UNKNOWN Left arm
C4591008 -2121189952 57/M/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Left arm
C4591008 -2123315776 23//
C4591008 -2123780672 37// FIRST DOSE 2020 -12-15Pfizer EK5730 Left arm
C4591008 -2124844096 51/F/WHITE FIRST DOSE 2020 -12-22Pfizer EJ1685 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073902
Listing 7.7.5 Page 164of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 452of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Left arm
C4591008 -2127049792 50/F/WHITE FIRST DOSE 2020 -12-30Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-22Pfizer UNKNOWN Left arm
C4591008 -2127807040 43//
C4591008 -2132829248 21/F/WHITE FIRST DOSE 2021 -01-03Pfizer EL1284 Right arm
SECOND DOSE 2021 -01-23Pfizer EL9262 Right arm
C4591008 -2138463296 35/F/WHITE FIRST DOSE 2020 -12-23Pfizer UNKNOWN Left arm
C4591008 -2138834496 45/F/WHITE FIRST DOSE 2020 -12-21Pfizer EK5730 Right arm
SECOND DOSE 2021 -01-11Pfizer EL3248 Right arm
C4591008 -2142681152 23/F/ASIAN FIRST DOSE 2021 -01-28Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -02-16Pfizer UNKNOWN Left arm
C4591008 -2143697984 49/F/WHITE FIRST DOSE 2021 -01-13Moderna 012L20a Left arm
SECOND DOSE 2021 -02-10Moderna 028L20a Left arm
C4591008 -2143750720 30/F/WHITE FIRST DOSE 2021 -01-15Pfizer EL1283 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073903
Listing 7.7.5 Page 165of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 453of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -02-05Pfizer EN5318 Left arm
C4591008 -2145637440 35//
C4591008 -2145638464 47/F/WHITE FIRST DOSE 2020 -12-29Pfizer EK9231 Right arm
C4591008 -2147577408 53/M/WHITE FIRST DOSE 2020 -12-22Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-19Pfizer EL1283 Left arm
C4591008 -2147671104 47/F/WHITE FIRST DOSE 2020 -12-30Moderna 011J20A Left arm
SECOND DOSE 2021 -01-29Moderna UNKNOWN Left arm
C4591008 -2148493888 35// FIRST DOSE 2020 -12-22Pfizer EK5730 Left arm
C4591008 -2150247488 57/F/WHITE FIRST DOSE 2020 -12-20Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-10Pfizer UNKNOWN Left arm
C4591008 -2153489472 32/M/WHITE FIRST DOSE 2021 -01-29Pfizer EL3247 Left arm
SECOND DOSE 2021 -02-19Pfizer EN6201 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073904
Listing 7.7.5 Page 166of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 454of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2153782336 28//
C4591008 -2154645568 24// FIRST DOSE 2020 -12-22Pfizer EJ1685 Left arm
C4591008 -2156253248 34/F/MULTIPL
EFIRST DOSE 2020 -12-15Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-06Pfizer EL1284 Left arm
C4591008 -2156958272 42/F/WHITE FIRST DOSE 2021 -01-06Pfizer Ek9231 Right arm
SECOND DOSE 2021 -01-28Pfizer El8982 Left arm
C4591008 -2157144128 56/F/WHITE FIRST DOSE 2021 -01-22Moderna 030L20A Left arm
SECOND DOSE 2021 -02-18Moderna 015M20A Left arm
C4591008 -2157861440 24/F/WHITE FIRST DOSE 2020 -12-31Pfizer EH9899 Right arm
SECOND DOSE 2021 -01-21Pfizer EL3248 Left arm
C4591008 -2162897472 53/F/WHITE FIRST DOSE 2020 -12-18Pfizer EH9899 Left arm
SECOND DOSE 2021 -01-07Pfizer UNKNOWN Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073905
Listing 7.7.5 Page 167of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 455of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
C4591008 -2165195840 27/F/ASIAN FIRST DOSE 2021 -01-13Pfizer EL1283 Left arm
SECOND DOSE 2021 -02-03Pfizer EL9264 Left arm
C4591008 -2165827136 29/M/WHITE FIRST DOSE 2021 -04-06Janssen 1805025 Left arm
C4591008 -2168836160 66/F/WHITE FIRST DOSE 2020 -12-22Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-12Pfizer UNKNOWN Left arm
C4591008 -2171015232 29/F/WHITE FIRST DOSE 2020 -12-22Pfizer E11284 Left arm
SECOND DOSE 2021 -01-12Pfizer Ek9331 Left arm
C4591008 -2171241024 40/F/WHITE FIRST DOSE 2020 -12-22Pfizer ek5730 Left arm
SECOND DOSE 2021 -01-14Pfizer EL3248 Left arm
UNKNOWN Left arm
C4591008 -2171719232 40/F/WHITE FIRST DOSE 2020 -12-18Pfizer UNKNOWN Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073906
Listing 7.7.5 Page 168of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 456of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-08Pfizer UNKNOWN Right arm
C4591008 -2173028928 53//
C4591008 -2178442816 45/F/WHITE FIRST DOSE 2020 -12-31Pfizer UNKNOWN Right arm
SECOND DOSE 2021 -01-19Pfizer EL3247 Right arm
EL8247 Arm (side
unknown)
C4591008 -2182308416 31// FIRST DOSE 2021 -01-09Moderna UNKNOWN Left arm
SECOND DOSE 2021 -02-06Moderna UNKNOWN Left arm
C4591008 -2182441536 41/F/ASIAN FIRST DOSE 2020 -12-21Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-08Pfizer EL3248 Left arm
C4591008 -2182468160 27/F/WHITE FIRST DOSE 2020 -12-29Pfizer EL1284 Right arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073907
Listing 7.7.5 Page 169of 1325
BNT162b2 Protocol C4591008
Medication/Treatment Data
PFIZER CONFIDENTIAL SDTM Creation: 11MAY2021:07:31:19 Data Cutoff: 29APR2021 Source Data: ADSL, EX
Generated from /dcri/ct/hero_together/lists/l_vax.sas on 24MAY2021 12:45 Page 457of 1689 Subject ID Age/Sex/Race Dose NumberDate of
Dose ManufacturerImputed
Date of
DoseImputed
Manufacturer Lot NumberInjection
Site Facility
SECOND DOSE 2021 -01-20Pfizer UNKNOWN Right arm
C4591008 -2183372352 59/F/WHITE FIRST DOSE 2020 -12-28Pfizer EJ1685 Left arm
SECOND DOSE 2021 -01-11Pfizer EL1283 Left arm
C4591008 -2183558208 50/F/NATIVE
HAWAIIAN OR
OTHERFIRST DOSE 2020 -12-22Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-13Pfizer UNKNOWN Right arm
C4591008 -2184195136 49/M/WHITE FIRST DOSE 2020 -12-30Moderna 025J02A Left arm
C4591008 -2185616960 58/F/WHITE FIRST DOSE 2020 -12-28Pfizer EL1284 Left arm
SECOND DOSE 2021 -01-18Pfizer EJ1686 Left arm
C4591008 -2187782208 32/F/NOT
REPORTEDFIRST DOSE 2020 -12-26Pfizer UNKNOWN Left arm
SECOND DOSE 2021 -01-11Pfizer EL1238 Left arm
090177e1972e4eaa\Approved\Approved On: 22-Jun-2021 15:08 (GMT)
(b) (6)
FDA-CBER-2021-5683-1073908
Listing 7.7.5 Page 170of 1325
BNT162b2 Protocol C459100
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