28T-37210-40360 · OpenVSafe

Timeline

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

2021-02-09
Dose 1 — Pfizer-BioNTech
2021-03-02
Dose 2 — Pfizer-BioNTech
2021-09-28
Dose 3 — Pfizer-BioNTech
2021-10-19
Registered in v-safe
2021-10-19
Health check-in — day 21, dose 3, dependent
Feeling: Good

Adult check-in
2021-11-03
Survey response — day 35, dose 3, dependent
MedDRA: Muscular weakness, Unevaluable event — Feeling: Fair · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Symptoms: Muscle weakness awaiting hip replacement surgery No internet our area kast 10 days due storm, and no landlines · Healthcare visit (other): See above

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Report sent to call center — day 35, dose 3, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2021-11-04
Call 1 — Left Voicemail
2021-11-04
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-09
Survey response — day 42, dose 3, dependent
MedDRA: Asthenia, Blood potassium decreased, Hospitalisation, Type 2 diabetes mellitus, Unevaluable event — Feeling: Poor · Be unable to do their normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Not Covid related She is currently in hospital due low potassium, loss of strength conplicated by type II diabetes while awaiting a hip replacement delayed by non vaxxed people with covid surge clogging the system · Healthcare visit (other): See above

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Report sent to call center — day 42, dose 3, dependent
Be unable to do their normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-11-11
Call 2 — Could Not Reach Participant
2021-12-28
Survey response — 3 months, dose 3
MedDRA: Death — Feeling: Poor

Free text: How do I answer these to help you Call me if you wish (b)(6) died 15 Nov 2021 in our local hospital In sadness (b)(6) -husband

MedDRA releases: 2024-11 · check-in free text available
2021-12-28
Survey response — 3 months, dose 3, dependent
MedDRA: Death — Feeling: Poor

Free text: I don't know how to properly answer on (b)(6) behalf Call me if you wish (b)(6) passed away 15Nov 2021 In sadness (b)(6) -husband of 54+ yrs

MedDRA releases: 2024-11 · check-in free text available
2022-09-28
Survey response — 12 months, dose 3, dependent
MedDRA: Death, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: Please remove (b)(6) from your list She is deceased as of (b)(6) · Healthcare visit (other): Answers trying to get your attention

MedDRA releases: 2024-11 · check-in free text available
2022-09-28
Report sent to call center — 12 months, dose 3, dependent
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-09-29
Call 1 — Left Voicemail
2022-09-29
Call 1 — Left Voicemail
2022-09-29
Call successful
Does not wish to fill out VAERS report
2022-09-29
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Pfizer-BioNTech	No
2	2021-03-02	Pfizer-BioNTech	No
3	2021-09-28	Pfizer-BioNTech	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 10 — day 35, dose 3, dependent

2021-11-03

Symptoms: Muscle weakness awaiting hip replacement surgery No internet our area kast 10 days due storm, and no landlines

Healthcare visit (other): See above

Release 10 — day 42, dose 3, dependent

2021-11-09

Symptoms: Not Covid related She is currently in hospital due low potassium, loss of strength conplicated by type II diabetes while awaiting a hip replacement delayed by non vaxxed people with covid surge clogging the system

Healthcare visit (other): See above

Release 10 — 3 months, dose 3, dependent

Reports this person's death

2021-12-28

Symptoms: I don't know how to properly answer on (b)(6) behalf Call me if you wish (b)(6) passed away 15Nov 2021 In sadness (b)(6) -husband of 54+ yrs

redacted (b)(6)

Release 10 — 3 months, dose 3

Reports this person's death

2021-12-28

Symptoms: How do I answer these to help you Call me if you wish (b)(6) died 15 Nov 2021 in our local hospital In sadness (b)(6) -husband

redacted (b)(6)

Release 12 — 12 months, dose 3, dependent

Reports this person's death

2022-09-28

Symptoms: Please remove (b)(6) from your list She is deceased as of (b)(6)

Healthcare visit (other): Answers trying to get your attention

redacted (b)(6)

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

MedDRA terms by release

Field	Preferred term	2021-09	2023-04	2024-11
HCVO	Unevaluable event	·	·	✓
SD	Asthenia	·	·	✓
SD	Blood potassium decreased	·	·	✓
SD	Death	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Muscular weakness	·	·	✓
SD	Type 2 diabetes mellitus	·	·	✓

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