36Z-21205-10017

4 vaccinations 10 coded responses 40 check-ins 9 free-text entries 6 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 201 / VA
Registered: 2021-03-10

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

2021-03-10
Registered in v-safe
2021-03-10
Dose 1 — Pfizer-BioNTech
2021-03-10
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-12
Survey response — days 1–6 daily, dose 1
MedDRA: Pain — Feeling: Good · Muscle or body aches

Free text: Aches due to spring gardening most likely

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Survey response — days 1–6 daily, dose 1
MedDRA: Pain — Feeling: Good · Muscle or body aches

Free text: Aches likely from activity

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-17
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-31
Dose 2 — Pfizer-BioNTech
2021-03-31
Survey response — day 0, dose 2
MedDRA: Skin infection — Feeling: Good

Free text: Skin infection lower left leg. On antibiotics (AMOX-CLAV 875mg) for 2 more days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — days 1–6 daily, dose 2
MedDRA: Pain, Somnolence — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Somewhat sleepless last night due to aches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Infection, Injury, Localised infection, Pre-existing disease, Unevaluable event — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Infection in R leg from injury (not related to immunization) · Healthcare visit (other): Due to infection following injury; not from immunization (as far as I know)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches

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

Adult check-in
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Limb injury, Office visit — Feeling: Good · Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Infected injury to lower leg. Taking Doxycycline. Probably not related to the vaccination. · Healthcare visit (other): Wound Healing clinic

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — day 7, dose 2
Feeling: Good · None

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

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

Adult check-in
2021-04-28
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-12
Survey response — day 42, dose 2
MedDRA: Localised infection, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Infection in right leg after accident with a rotary plow & buried rebar. Didnt heal. Now in fifth week at wound care clinic. Improving. · Healthcare visit (other): Wound care clinic

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-10
Call 1 — Left Voicemail
2021-06-30
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-29
Survey response — 6 months, dose 2
MedDRA: Condition aggravated, Pre-existing disease, Spinal fusion surgery, Spinal laminectomy — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Recurrence of spinal stenosis. Laminectomy & fusion L3-L4 & L5-S1 last month. L4-L5 done 2 years ago. NOT related to vaccination or COVID. Knew years ago that my spine was deteriorating .

MedDRA releases: 2024-11 · check-in free text available
2021-09-29
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2021-10-01
Call 1 — Left Voicemail
2021-10-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-02
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-09-20
Dose 3 — Moderna
Co-administered: Flu
2022-09-20
Health check-in — day 0, dose 3
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-21
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains

Adult check-in
2022-09-23
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains

Adult check-in
2022-09-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains

Adult check-in
2022-09-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-09-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains

Adult check-in
2022-09-27
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2022-10-04
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2022-10-05
Dose 4 — Pfizer-BioNTech
Co-administered: Flu
2022-10-11
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-10-18
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-10-25
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-11-01
Survey response — day 42, dose 3
MedDRA: Influenza, Nasopharyngitis, SARS-CoV-2 test negative — 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

Free text: Head cold or start of fly. Home COVID test was negative.

MedDRA releases: 2024-11 · check-in free text available
2022-11-01
Report sent to call center — day 42, 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)
2022-11-02
Call 1 — Left Voicemail
2022-11-02
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-20
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2023-04-05
Survey response — 6 months, dose 4
MedDRA: Bradycardia, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-04-05
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2023-04-06
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-10	Pfizer-BioNTech
2	2021-03-31	Pfizer-BioNTech
3	2022-09-20	Moderna	Flu
4	2022-10-05	Pfizer-BioNTech	Flu

Call center

6 call center cases

5 successful · 1 unsuccessful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-12

Systemic reaction (other): Aches due to spring gardening most likely

2021-03-13

Systemic reaction (other): Aches likely from activity

Release 6 — day 0, dose 2

2021-03-31

Systemic reaction (other): Skin infection lower left leg. On antibiotics (AMOX-CLAV 875mg) for 2 more days

Release 6 — days 1–6 daily, dose 2

2021-04-01

Systemic reaction (other): Somewhat sleepless last night due to aches

2021-04-02

Systemic reaction (other): Infection in R leg from injury (not related to immunization)

Healthcare visit (other): Due to infection following injury; not from immunization (as far as I know)

2021-04-05

Systemic reaction (other): Infected injury to lower leg. Taking Doxycycline. Probably not related to the vaccination.

Healthcare visit (other): Wound Healing clinic

Release 8 — day 42, dose 2

2021-05-12

Symptoms: Infection in right leg after accident with a rotary plow & buried rebar. Didnt heal. Now in fifth week at wound care clinic. Improving.

Healthcare visit (other): Wound care clinic

Release 9 — 6 months, dose 2

2021-09-29

Symptoms: Recurrence of spinal stenosis. Laminectomy & fusion L3-L4 & L5-S1 last month. L4-L5 done 2 years ago. NOT related to vaccination or COVID. Knew years ago that my spine was deteriorating .

Release 12 — day 42, dose 3

2022-11-01

Symptoms: Head cold or start of fly. Home COVID test was negative.

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	Infection	✓	·	✓
HCVO	Injury	✓	·	✓
HCVO	Office visit	✓	✓	✓
HCVO	Unevaluable event	○	✓	○
SD	Bradycardia	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Influenza	·	·	✓
SD	Localised infection	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Spinal fusion surgery	·	·	✓
SD	Spinal laminectomy	·	·	✓
SRO	Injury	✓	·	✓
SRO	Limb injury	✓	✓	✓
SRO	Localised infection	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pre-existing disease	○	✓	○
SRO	Skin infection	✓	✓	✓
SRO	Somnolence	✓	✓	✓

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