2LV-54977-66229

2 vaccinations 5 coded responses 8 check-ins 5 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 480 / MI
Registered: 2021-02-24

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

2021-01-28
Dose 1 — Pfizer-BioNTech
2021-02-18
Dose 2 — Pfizer-BioNTech
2021-02-24
Registered in v-safe
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-02-25
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-04
Survey response — day 14, dose 2
MedDRA: Emergency care, Eye contusion, Fall, Fatigue, Haematoma, Hospitalisation, Rib fracture, Subarachnoid haemorrhage — Feeling: Poor · 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: Symptoms: I fell face down on hardwood floor resulting in Subarachnoid Hemorrhage (SAH). Hematoma on leg, cracked rib, two black eyes down to cheekbones. Seems like I tripped but wonder why and if I was affected by the vaccine. Felt very tired after shot two. · Healthcare visit (other): EMS, Emergency and ICU

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-11
Survey response — day 21, dose 2
MedDRA: Fall, Gait disturbance, Malaise, Office visit, Subarachnoid haemorrhage — Feeling: Poor · 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: Symptoms: SAH hemorrhage after falling. Trauma. I did not feel well at all but think that I tripped. WasIt due to weakness? Fatigue? · Healthcare visit (other): Follow up with neurologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-18
Health check-in — day 28, dose 2
Feeling: Poor

Adult check-in
2021-03-25
Survey response — day 35, dose 2
MedDRA: Asthenia, Cerebral haemorrhage, Fall, Fatigue, Functional gastrointestinal disorder, Hospitalisation, Pain, Subarachnoid haemorrhage — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Severe pain and into the hospital for second time in 3 weeks. FirstStay due to brain hemorrhage (SAH) after fall from weakness and fatigue. Pain causedBowel to stop function. Thought it was blocked but it clear up.However pain is still bad · Healthcare visit (other): Morphine drip for pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-01
Survey response — day 42, dose 2
MedDRA: Asthenia, Fall, Fatigue, Ileus, Intestinal obstruction, Intracardiac thrombus, Medical counselling, Pre-existing disease, Pulmonary thrombosis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Blocked bowel due to Illius. Blood clots in legs from priorCondition. Now in my lungs and one in my heart. All followed a tripAnd fall after feeling weak and fatigued 3-5 days after second vaccination. · Healthcare visit (other): Now Hime health care for blood draws while on coumedin

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-20
Survey response — 3 months, dose 2
MedDRA: Hospitalisation, Thrombosis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Blood clots in legs, heart and lungs. Now on Coumadin. Hospitalized three times ; Mar, Apr, May.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-14
Callback requested for
01:30PM ET
2021-06-14
Callback requested for
01:30PM ET
2021-06-14
Callback requested for
01:30PM ET
2021-06-14
Callback requested for
01:30PM ET
2021-06-14
Call 1 — Left Voicemail
2021-06-14
Callback requested for
01:30PM ET
2021-06-17
Call 2 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-28	Pfizer-BioNTech
2	2021-02-18	Pfizer-BioNTech

Call center

5 call center cases

5 unsuccessful

2 waits over 3 months for a first call

See the call center timeline

Free text

Release 5 — day 14, dose 2

2021-03-04

Symptoms: I fell face down on hardwood floor resulting in Subarachnoid Hemorrhage (SAH). Hematoma on leg, cracked rib, two black eyes down to cheekbones. Seems like I tripped but wonder why and if I was affected by the vaccine. Felt very tired after shot two. cut off by CDC

Healthcare visit (other): EMS, Emergency and ICU

Release 5 — day 21, dose 2

2021-03-11

Symptoms: SAH hemorrhage after falling. Trauma. I did not feel well at all but think that I tripped. WasIt due to weakness? Fatigue?

Healthcare visit (other): Follow up with neurologist

Release 6 — day 35, dose 2

2021-03-25

Symptoms: Severe pain and into the hospital for second time in 3 weeks. FirstStay due to brain hemorrhage (SAH) after fall from weakness and fatigue. Pain causedBowel to stop function. Thought it was blocked but it clear up.However pain is still bad

Healthcare visit (other): Morphine drip for pain

Release 6 — day 42, dose 2

2021-04-01

Symptoms: Blocked bowel due to Illius. Blood clots in legs from priorCondition. Now in my lungs and one in my heart. All followed a tripAnd fall after feeling weak and fatigued 3-5 days after second vaccination.

Healthcare visit (other): Now Hime health care for blood draws while on coumedin

Release 8 — 3 months, dose 2

2021-05-20

Symptoms: Blood clots in legs, heart and lungs. Now on Coumadin. Hospitalized three times ; Mar, Apr, May.

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	Emergency care	✓	✓	✓
HCVO	Hospitalisation	✓	✓	✓
HCVO	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Pain	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Cerebral haemorrhage	○	✓	○
SD	Eye contusion	✓	✓	✓
SD	Fall	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Functional gastrointestinal disorder	✓	✓	✓
SD	Gait disturbance	✓	✓	✓
SD	Haematoma	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Ileus	✓	✓	✓
SD	Intestinal obstruction	✓	✓	✓
SD	Intracardiac thrombus	✓	✓	✓
SD	Malaise	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pulmonary thrombosis	✓	✓	✓
SD	Rib fracture	✓	✓	✓
SD	Subarachnoid haemorrhage	✓	✓	✓
SD	Thrombosis	✓	✓	✓

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