3EC-31102-77721

4 vaccinations 13 coded responses 37 check-ins 12 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 601 / IL
Registered: 2021-02-17

Relationship: Self
Race: White
Ethnicity: N/A

Timeline

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

2021-02-17
Registered in v-safe
2021-02-17
Dose 1 — Pfizer-BioNTech
2021-02-17
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-02-19
Survey response — days 1–6 daily, dose 1
MedDRA: Muscle spasms — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Free text: Spasam in my left hip turning over in bed.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-24
Health check-in — day 7, dose 1
Feeling: Fair · Fatigue or tiredness, Abdominal pain

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

Adult check-in
2021-03-10
Dose 2 — Pfizer-BioNTech
2021-03-17
Health check-in — day 7, dose 2
Feeling: Good · Headache

Adult check-in
2021-03-24
Survey response — day 14, dose 2
MedDRA: Chills, Fatigue, Headache — Feeling: Good · Be unable to do your normal daily activities

Free text: Headaches, chills,tiredness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — day 21, dose 2
MedDRA: Lower respiratory tract infection, Nasopharyngitis — Feeling: Fair · Be unable to do your normal daily activities

Free text: Head cold went to my chest.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-15
Survey response — day 35, dose 2
MedDRA: Pain in extremity, Vision blurred — Feeling: Good

Free text: I have developed a very sore right index finger first knuckle. Also my vision when first awake is like looking through glass with water running over it ie in motion.never had either before, but I am 66 and was never that before. Comes and goes.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-09
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Injection site pain, Pain — Feeling: Good

Free text: Sorness radiating out from injection sight into sholder elbow and side. Now today into other sholder.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-10
Survey response — 6 months, dose 2
MedDRA: Diarrhoea, Pyrexia, SARS-CoV-2 test negative — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Low grade fever, diarrehea. · Healthcare visit (other): Covid rapid test. Neg.

MedDRA releases: 2024-11 · check-in free text available
2021-09-10
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-14
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-28
Dose 3 — Pfizer-BioNTech
2021-10-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

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

Adult check-in
2021-10-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-05
Health check-in — day 7, dose 3
Feeling: Good · None

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
Survey response — day 28, dose 3
MedDRA: Rash, Vaccine positive rechallenge — Feeling: Good

Free text: Same rash as first to injections. Little here and there.

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-09
Survey response — day 42, dose 3
MedDRA: Diarrhoea, Muscle spasms — Feeling: Good

Free text: Sice vac, have a cycling loose bowel day with lots of cramping.

MedDRA releases: 2024-11 · check-in free text available
2021-12-28
Survey response — 3 months, dose 3
MedDRA: Oropharyngeal pain, Pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Aches and pains, sore throat enough to go get tested. Negative on quick, still waiting for results for long test.

MedDRA releases: 2024-11 · check-in free text available
2022-03-29
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-03-30
Dose 4 — Pfizer-BioNTech
2022-04-15
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-20
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-04-27
Survey response — day 28, dose 4
MedDRA: Brain fog, Eye pain, Fatigue, Feeling hot, Headache — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Pain behind the eyes headache, feel feverish without a fever. Tired strangely foggy in my thinking.

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-11
Survey response — day 42, dose 4
MedDRA: Bronchitis, Chills — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Bad bronchial infection, chills.

MedDRA releases: 2024-11 · check-in free text available
2022-06-29
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-28
Survey response — 6 months, dose 4
MedDRA: Arthralgia, Oropharyngeal pain, Pyrexia — Feeling: Fair

Free text: Sore throat, feverish, but without a fever. Sore in shoulders.

MedDRA releases: 2024-11 · check-in free text available
2023-03-30
Survey response — 12 months, dose 4
MedDRA: Nasopharyngitis, Unevaluable event — Feeling: Good · Be unable to work or attend school

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-17	Pfizer-BioNTech
2	2021-03-10	Pfizer-BioNTech
3	2021-09-28	Pfizer-BioNTech	No
4	2022-03-30	Pfizer-BioNTech	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-19

Systemic reaction (other): Spasam in my left hip turning over in bed.

Release 6 — day 14, dose 2

2021-03-24

Symptoms: Headaches, chills,tiredness.

Release 6 — day 21, dose 2

2021-03-31

Symptoms: Head cold went to my chest.

Release 7 — day 35, dose 2

2021-04-15

Symptoms: I have developed a very sore right index finger first knuckle. Also my vision when first awake is like looking through glass with water running over it ie in motion.never had either before, but I am 66 and was never that before. Comes and goes.

Release 9 — 3 months, dose 2

2021-06-09

Symptoms: Sorness radiating out from injection sight into sholder elbow and side. Now today into other sholder.

Release 9 — 6 months, dose 2

2021-09-10

Symptoms: Low grade fever, diarrehea.

Healthcare visit (other): Covid rapid test. Neg.

Release 10 — day 28, dose 3

2021-10-26

Symptoms: Same rash as first to injections. Little here and there.

Release 10 — day 42, dose 3

2021-11-09

Symptoms: Sice vac, have a cycling loose bowel day with lots of cramping.

Release 10 — 3 months, dose 3

2021-12-28

Symptoms: Aches and pains, sore throat enough to go get tested. Negative on quick, still waiting for results for long test.

Release 11 — day 28, dose 4

2022-04-27

Symptoms: Pain behind the eyes headache, feel feverish without a fever. Tired strangely foggy in my thinking.

Release 11 — day 42, dose 4

2022-05-11

Symptoms: Bad bronchial infection, chills.

Release 12 — 6 months, dose 4

2022-09-28

Symptoms: Sore throat, feverish, but without a fever. Sore in shoulders.

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	SARS-CoV-2 test negative	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Brain fog	·	·	✓
SD	Bronchitis	·	·	✓
SD	Chills	✓	✓	✓
SD	Diarrhoea	·	·	✓
SD	Eye pain	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Feeling hot	·	·	✓
SD	Headache	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Lower respiratory tract infection	✓	✓	✓
SD	Muscle spasms	·	·	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	Rash	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Vaccine positive rechallenge	·	·	✓
SD	Vision blurred	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓

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