26M-11106-18506

5 vaccinations 6 coded responses 53 check-ins 6 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 379 / TN
Registered: 2020-12-31

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2020-12-31
Registered in v-safe
2020-12-31
Dose 1 — Pfizer-BioNTech
2020-12-31
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-07
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-14
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-21
Dose 2 — Pfizer-BioNTech
2021-01-21
Survey response — day 0, dose 2
MedDRA: Disturbance in attention — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work

Free text: Difficulty concentrating

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-01-24
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Light headed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Muscle or body aches

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-28
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-11
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-18
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-22
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-08
Dose 3 — Pfizer-BioNTech
2021-10-23
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-10-29
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-05
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-12
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-07
Survey response — 3 months, dose 3
MedDRA: Brain fog, Fatigue, Headache, Influenza like illness, Influenza virus test negative, Pain, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Flu-like, headache, body aches, fatigue. No fever. Brain fog similar to 2nd dose of vaccine. Duration about 3 days. Covid (rapid and PCR) and flu tests negative on day 1 of symptoms.

MedDRA releases: 2024-11 · check-in free text available
2022-01-07
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-10
Call 1 — Left Voicemail
2022-01-11
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-08
Survey response — 6 months, dose 3
MedDRA: Influenza like illness, Influenza virus test negative, Respiratory symptom, SARS-CoV-2 test negative — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Flu like symptoms few months ago negative COVID and Flu tests within 24 hours of onset. URI symptoms last few days continuing today.

MedDRA releases: 2024-11 · check-in free text available
2022-04-08
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-12
Dose 4 — Pfizer-BioNTech
2022-04-14
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-19
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-04-26
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-03
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-10
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-12
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-10-06
Dose 5 — Moderna
2022-10-06
Health check-in — day 0, dose 5
Feeling: Good · Site: Pain · None

Adult check-in
2022-10-07
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Headache

Adult check-in
2022-10-08
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Diarrhea

Adult check-in
2022-10-09
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · None

Adult check-in
2022-10-10
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-11
Survey response — days 1–6 daily, dose 5
MedDRA: Hypoaesthesia, Paraesthesia — Feeling: Good

Free text: Numbness and tingling in fingertips

MedDRA releases: 2024-11 · check-in free text available
2022-10-12
Survey response — days 1–6 daily, dose 5
MedDRA: Hypoaesthesia, Paraesthesia — Feeling: Good

Free text: Slight numbness and tingling of fingertips

MedDRA releases: 2024-11 · check-in free text available
2022-10-13
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2022-10-22
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-27
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-03
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-10
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-17
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-05
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-04-06
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-31	Pfizer-BioNTech
2	2021-01-21	Pfizer-BioNTech
3	2021-10-08	Pfizer-BioNTech	No
4	2022-04-12	Pfizer-BioNTech	No
5	2022-10-06	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 2 — day 0, dose 2

2021-01-21

Systemic reaction (other): Difficulty concentrating

Release 2 — days 1–6 daily, dose 2

2021-01-24

Systemic reaction (other): Light headed

Release 10 — 3 months, dose 3

2022-01-07

Symptoms: Flu-like, headache, body aches, fatigue. No fever. Brain fog similar to 2nd dose of vaccine. Duration about 3 days. Covid (rapid and PCR) and flu tests negative on day 1 of symptoms.

Release 11 — 6 months, dose 3

2022-04-08

Symptoms: Flu like symptoms few months ago negative COVID and Flu tests within 24 hours of onset. URI symptoms last few days continuing today.

Release 12 — days 1–6 daily, dose 5

2022-10-11

Systemic reaction (other): Numbness and tingling in fingertips

2022-10-12

Systemic reaction (other): Slight numbness and tingling of fingertips

Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".

MedDRA terms by release

Field	Preferred term	2021-09	2023-04	2024-11
SD	Brain fog	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Influenza like illness	·	·	✓
SD	Influenza virus test negative	·	·	✓
SD	Pain	·	·	✓
SD	Respiratory symptom	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Disturbance in attention	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Hypoaesthesia	·	·	✓
SRO	Paraesthesia	·	·	✓

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