3AY-17939-85877

4 vaccinations 3 coded responses 38 check-ins 2 free-text entries 3 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 983 / WA
Registered: 2020-12-23

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

2020-12-23
Registered in v-safe
2020-12-23
Dose 1 — Pfizer-BioNTech
2020-12-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2020-12-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-30
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-13
Dose 2 — Pfizer-BioNTech
2021-01-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-13
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-20
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-03
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-17
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-02-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-14
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-08-20
Dose 3 — Pfizer-BioNTech
2022-01-13
Survey response — 12 months, dose 2
MedDRA: COVID-19 — 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 · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Covid infection

MedDRA releases: 2024-11 · check-in free text available
2022-01-13
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

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-01-14
Call 1 — Left Voicemail
2022-04-23
Dose 4 — Moderna
2022-04-23
Health check-in — day 0, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-04-24
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache

Adult check-in
2022-04-26
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-27
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-28
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-30
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-07
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-14
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-21
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-28
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-04
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-23
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-22
Survey response — 6 months, dose 4
MedDRA: Asthma, COVID-19, Fatigue, Pre-existing disease — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Recent COVID, fatigue, asthma flare

MedDRA releases: 2024-11 · check-in free text available
2022-10-22
Report sent to call center — 6 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-23
Survey response — 12 months, dose 4
MedDRA: Diverticulitis intestinal perforated — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11
2023-04-23
Report sent to call center — 12 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2023-04-24
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-23	Pfizer-BioNTech
2	2021-01-13	Pfizer-BioNTech
3	2021-08-20	Pfizer-BioNTech	No
4	2022-04-23	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-01-13	Successful 2022-10-26	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-22	Successful 2022-10-26	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-23	Unsuccessful

Free text

Release 10 — 12 months, dose 2

2022-01-13

Symptoms: Covid infection

Release 12 — 6 months, dose 4

2022-10-22

Symptoms: Recent COVID, fatigue, asthma flare

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	Asthma	·	·	✓
SD	COVID-19	·	·	✓
SD	Diverticulitis intestinal perforated	·	·	✓
SD	Fatigue	·	·	✓
SD	Pre-existing disease	·	·	✓

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