2KS-82939-65894

5 vaccinations 14 coded responses 40 check-ins 13 free-text entries 2 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 151 / PA
Registered: 2021-01-11

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

2020-12-21
Dose 1 — Pfizer-BioNTech
2021-01-08
Dose 2 — Pfizer-BioNTech
2021-01-11
Registered in v-safe
2021-01-13
Survey response — days 1–6 daily, dose 2
MedDRA: Dehydration — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Feel dehydrated

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Survey response — day 7, dose 2
MedDRA: Asthenia, Musculoskeletal chest pain, Myalgia — Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Free text: Reduced energy and muscle aches around rib cage

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-01-29
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-05
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-12
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-02-19
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-09
Survey response — 3 months, dose 2
MedDRA: Sacral pain, Sciatica — Feeling: Good

Free text: Sacrum & Sciatic pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-09
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-09-28
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2021-09-29
Survey response — days 1–6 daily, dose 3
MedDRA: Epistaxis — Feeling: Good

Free text: Bloody nose

MedDRA releases: 2024-11 · check-in free text available
2021-09-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2021-10-01
Survey response — days 1–6 daily, dose 3
MedDRA: Dehydration — Feeling: Good · Fatigue or tiredness

Free text: Feel a bit dehydrated

MedDRA releases: 2024-11 · check-in free text available
2021-10-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Muscle or body aches

Adult check-in
2021-10-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-05
Health check-in — day 7, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-10-12
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-10-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-10-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-02
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-28
Survey response — 3 months, dose 3
MedDRA: Adverse reaction, Cough, SARS-CoV-2 test negative — Feeling: Fair

Free text: Allergy like w/ intermittent irritation dry cough, no fever or other symptoms. Did home COVID test on Dec 24th to assure all family of 6 guests were safe and all texted negative.

MedDRA releases: 2024-11 · check-in free text available
2022-03-29
Survey response — 6 months, dose 3
MedDRA: Abdominal symptom, Burning sensation, Oesophagitis, 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: Esophagitis w/ burning for past 3 months. Endoscopy scheduled tomorrow 3/30/22. I was concerned initial abdominal symptoms so Took 2 flex/flow home COVID test 5-6 days apart 12/31/21 and 1/5/22 both NEGATIVE

MedDRA releases: 2024-11 · check-in free text available
2022-03-29
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)
2022-03-30
Call 1 — Left Voicemail
2022-04-16
Dose 4 — Moderna
2022-04-19
Survey response — days 1–6 daily, dose 4
MedDRA: Discomfort, Musculoskeletal discomfort — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Sacral back and rib discomfort

MedDRA releases: 2024-11 · check-in free text available
2022-04-20
Survey response — days 1–6 daily, dose 4
MedDRA: Burning sensation, Discomfort, Fatigue, Myalgia, Oral discomfort, Reaction to previous exposure to any vaccine, Sacral pain — Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Free text: Sacral pain. Burning mouth, and upper GI burning I've had since Dec 28th,2021 seems to be more pronounced since 4/16/22. Fatigue worse than I experienced with my 3 prior Pfizer vaccines. Rib cage and right sided flank discomfort like muscle aches

MedDRA releases: 2024-11 · check-in free text available
2022-04-22
Survey response — days 1–6 daily, dose 4
MedDRA: Musculoskeletal stiffness, Oesophageal discomfort, Oral discomfort, Sacral pain — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Sacral pain & stiffness, burning mouth & upper esophageal discomfort

MedDRA releases: 2024-11 · check-in free text available
2022-04-23
Survey response — day 7, dose 4
MedDRA: Discomfort, Oesophageal pain, Oral discomfort — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Sacral discomfort, esophageal and mouth burn

MedDRA releases: 2024-11 · check-in free text available
2022-04-30
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-07
Survey response — day 21, dose 4
MedDRA: Burning mouth syndrome — Feeling: Fair

Free text: Burning mouth syndrome

MedDRA releases: 2024-11 · check-in free text available
2022-05-14
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-05-21
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-05-28
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-16
Survey response — 3 months, dose 4
MedDRA: Condition aggravated, Gastrointestinal disorder, Oral discomfort, Pre-existing disease — Feeling: Fair · 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: GI symptoms worsening along with burning mouth symptoms. Hard to tell if related to vaccine but symptoms have gotten worse since vaccine and medications increased 20mg to 40mg (omeprazole, Pepcid) and recently added gabapentin.

MedDRA releases: 2024-11 · check-in free text available
2022-07-16
Report sent to call center — 3 months, dose 4
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)
2022-07-19
Call successful
Participant prefers to complete VAERS report online
2022-07-19
Call successful
Participant prefers to complete VAERS report online
2022-09-22
Dose 5 — Moderna
2022-10-15
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2022-10-15
Health check-in — day 21, dose 5
Feeling: Fair

Adult check-in
2022-10-22
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-10-27
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2022-11-03
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2022-12-22
Health check-in — 3 months, dose 5
Feeling: Fair

Adult check-in
2023-03-23
Survey response — 6 months, dose 5
MedDRA: COVID-19, Diarrhoea, Discomfort, Fatigue, Hepatobiliary scan abnormal, Nausea, Oropharyngeal pain, SARS-CoV-2 test positive — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-21	Pfizer-BioNTech
2	2021-01-08	Pfizer-BioNTech
3	2021-09-28	Pfizer-BioNTech	Flu
4	2022-04-16	Moderna	No
5	2022-09-22	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 2

2021-01-13

Systemic reaction (other): Feel dehydrated

Release 2 — day 7, dose 2

2021-01-15

Systemic reaction (other): Reduced energy and muscle aches around rib cage

Release 7 — 3 months, dose 2

2021-04-09

Symptoms: Sacrum & Sciatic pain

Release 9 — days 1–6 daily, dose 3

2021-09-29

Systemic reaction (other): Bloody nose

2021-10-01

Systemic reaction (other): Feel a bit dehydrated

Release 10 — 3 months, dose 3

2021-12-28

Symptoms: Allergy like w/ intermittent irritation dry cough, no fever or other symptoms. Did home COVID test on Dec 24th to assure all family of 6 guests were safe and all texted negative.

Release 11 — 6 months, dose 3

2022-03-29

Symptoms: Esophagitis w/ burning for past 3 months. Endoscopy scheduled tomorrow 3/30/22. I was concerned initial abdominal symptoms so Took 2 flex/flow home COVID test 5-6 days apart 12/31/21 and 1/5/22 both NEGATIVE

Release 11 — days 1–6 daily, dose 4

2022-04-19

Systemic reaction (other): Sacral back and rib discomfort

2022-04-20

Systemic reaction (other): Sacral pain. Burning mouth, and upper GI burning I've had since Dec 28th,2021 seems to be more pronounced since 4/16/22. Fatigue worse than I experienced with my 3 prior Pfizer vaccines. Rib cage and right sided flank discomfort like muscle aches cut off by CDC

2022-04-22

Systemic reaction (other): Sacral pain & stiffness, burning mouth & upper esophageal discomfort

Release 11 — day 7, dose 4

2022-04-23

Systemic reaction (other): Sacral discomfort, esophageal and mouth burn

Release 11 — day 21, dose 4

2022-05-07

Symptoms: Burning mouth syndrome

Release 12 — 3 months, dose 4

2022-07-16

Symptoms: GI symptoms worsening along with burning mouth symptoms. Hard to tell if related to vaccine but symptoms have gotten worse since vaccine and medications increased 20mg to 40mg (omeprazole, Pepcid) and recently added gabapentin.

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 symptom	·	·	✓
SD	Adverse reaction	·	·	✓
SD	Burning mouth syndrome	·	·	✓
SD	Burning sensation	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Discomfort	·	·	✓
SD	Fatigue	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Hepatobiliary scan abnormal	·	·	✓
SD	Nausea	·	·	✓
SD	Oesophagitis	·	·	✓
SD	Oral discomfort	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Sacral pain	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sciatica	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Burning sensation	·	·	✓
SRO	Dehydration	✓	✓	✓
SRO	Discomfort	·	·	✓
SRO	Epistaxis	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Musculoskeletal chest pain	✓	✓	✓
SRO	Musculoskeletal discomfort	·	·	✓
SRO	Musculoskeletal stiffness	·	·	✓
SRO	Myalgia	✓	✓	✓
SRO	Oesophageal discomfort	·	·	✓
SRO	Oesophageal pain	·	·	✓
SRO	Oral discomfort	·	·	✓
SRO	Reaction to previous exposure to any vaccine	·	·	✓
SRO	Sacral pain	·	·	✓

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