29S-33960-40734

2 vaccinations 5 coded responses 24 check-ins 5 free-text entries 4 call cases

Sex: Male
Age at first dose: 36-40
ZIP prefix: 197 / DE
Registered: 2021-03-04

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-03-04
Registered in v-safe
2021-03-04
Dose 1 — Pfizer-BioNTech
2021-03-04
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-18
Survey response — day 14, dose 1
MedDRA: Abdominal pain upper, Cerebral palsy, Fatigue, Headache, Pre-existing disease — Feeling: Good · Be unable to work

Free text: I had a stomach ache and a headache 7 days post vaccination...only lasted half the day...missed work just that day...intermittent fatigue persist...I have Cerebral Palsy...is this a concern? Thank you

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-01
Dose 2 — Pfizer-BioNTech
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Headache, Fatigue or tiredness · Be unable to work

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-08
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-16
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-29
Survey response — day 28, dose 2
MedDRA: Abdominal pain, Presyncope — Feeling: Good · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Abdominal pain with near syncope... had to be taken to ER by ambulance

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Report sent to call center — day 28, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-06
Survey response — day 35, dose 2
MedDRA: Emergency care, Occult blood positive — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Positive guaiac test at ER...waiting for GI appointment on the 12th

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Report sent to call center — day 35, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-13
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-30
Survey response — 6 months, dose 2
MedDRA: Haemorrhage, Mineral supplementation, Transfusion, Upper gastrointestinal haemorrhage — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Upper GI bleed and blood loss requiring blood and iron transfusions

MedDRA releases: 2024-11 · check-in free text available
2021-09-30
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-10-04
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-01
Survey response — 12 months, dose 2
MedDRA: Anaemia, Intestinal haemorrhage, Iron deficiency — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Anemia secondary to intestinal bleeding requiring blood transfusions Iron deficiency requiring iron infusions

MedDRA releases: 2024-11 · check-in free text available
2022-04-01
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-04-04
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-04	Pfizer-BioNTech
2	2021-04-01	Pfizer-BioNTech

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 5 — day 14, dose 1

2021-03-18

Symptoms: I had a stomach ache and a headache 7 days post vaccination...only lasted half the day...missed work just that day...intermittent fatigue persist...I have Cerebral Palsy...is this a concern? Thank you

Release 8 — day 28, dose 2

2021-04-29

Symptoms: Abdominal pain with near syncope... had to be taken to ER by ambulance

Release 8 — day 35, dose 2

2021-05-06

Symptoms: Positive guaiac test at ER...waiting for GI appointment on the 12th

Release 9 — 6 months, dose 2

2021-09-30

Symptoms: Upper GI bleed and blood loss requiring blood and iron transfusions

Release 11 — 12 months, dose 2

2022-04-01

Symptoms: Anemia secondary to intestinal bleeding requiring blood transfusions Iron deficiency requiring iron infusions

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	Abdominal pain	✓	✓	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Anaemia	·	·	✓
SD	Cerebral palsy	✓	✓	✓
SD	Emergency care	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Haemorrhage	·	·	✓
SD	Headache	✓	✓	✓
SD	Intestinal haemorrhage	·	·	✓
SD	Iron deficiency	·	·	✓
SD	Mineral supplementation	·	·	✓
SD	Occult blood positive	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Presyncope	✓	✓	✓
SD	Transfusion	·	·	✓
SD	Upper gastrointestinal haemorrhage	·	·	✓

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