3J3-11395-96955

4 vaccinations 12 coded responses 33 check-ins 12 free-text entries 2 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 930 / CA
Registered: 2021-05-03

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

2021-04-07
Dose 1 — Pfizer-BioNTech
2021-04-28
Dose 2 — Pfizer-BioNTech
2021-05-03
Registered in v-safe
2021-05-03
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Fatigue, Nausea — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: I had severe nausea (and chills) for 24 hours. It started 12 hours after my 2nd injection. I had fatigue for 2 days after that. I feel OK now though.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Pre-existing disease — Feeling: Fair · Fever · Fatigue or tiredness

Free text: I have lower back pain today but I had that before the 1st injection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-12
Survey response — day 14, dose 2
MedDRA: Back pain, Fatigue, Pre-existing disease — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: I had an HSV1 outbreak. I think I may have been fighting that since before the first vaccine dose. I had backache and fatigue a couple days before the first dose. I'd only had one other outbreak since 2008 so I didn't recognize the symptoms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-27
Survey response — 6 months, dose 2
MedDRA: Painful respiration — Feeling: Good

Free text: Yesterday I woke with pain on inhale, that lasted all day but was gone this morning.

MedDRA releases: 2024-11 · check-in free text available
2021-12-30
Dose 3 — Pfizer-BioNTech
2022-01-05
Survey response — days 1–6 daily, dose 3
MedDRA: Adverse reaction — Feeling: Fair · Fatigue or tiredness

Free text: It's been a week since I had my shot so most of the symptoms are gone.

MedDRA releases: 2024-11 · check-in free text available
2022-01-06
Survey response — day 7, dose 3
MedDRA: Malaise — Feeling: Good

Free text: I was very sick for 2 days starting 6 hours after the shot.

MedDRA releases: 2024-11 · check-in free text available
2022-01-13
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-01-20
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-01-27
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2022-02-03
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-02-11
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-03-31
Survey response — 3 months, dose 3
MedDRA: Unevaluable event — 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

Free text: Symptoms: I believe I've been experiencing Autonomic neuropathy. It became serious on approx 2/11/22. It seems a bit better now but I have an appointment next week with my new clinic. I moved to a new county mid Feb and haven't been able to get an appointment. · Healthcare visit (other): Still waiting

MedDRA releases: 2024-11 · check-in free text available
2022-03-31
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2022-04-04
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-30
Survey response — 6 months, dose 3
MedDRA: Arrhythmia, Dyspnoea, Fatigue — 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 · Outpatient clinic or urgent care clinic visit

Free text: I had shortness of breath, fatigue and heart arrythmia.

MedDRA releases: 2024-11 · check-in free text available
2022-06-30
Report sent to call center — 6 months, dose 3
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 · 1 call case(s)
2022-07-01
Call successful
Does not wish to fill out VAERS report
2022-11-20
Dose 4 — Pfizer-BioNTech
2022-11-21
Survey response — days 1–6 daily, dose 4
MedDRA: Insomnia — Feeling: Poor · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: sleeplessness

MedDRA releases: 2024-11 · check-in free text available
2022-11-22
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-11-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-11-24
Survey response — days 1–6 daily, dose 4
MedDRA: Cough, Dry mouth, Dry throat, Epistaxis, Nasal dryness — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: dry bloody nose

MedDRA releases: 2024-11 · check-in free text available
2022-11-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-11-26
Survey response — days 1–6 daily, dose 4
MedDRA: Epistaxis, Nasal dryness — Feeling: Good

Free text: dry bloody nose this morning

MedDRA releases: 2024-11 · check-in free text available
2022-11-27
Survey response — day 7, dose 4
MedDRA: Epistaxis, Nasal dryness — Feeling: Good

Free text: dry bloody nose this morning

MedDRA releases: 2024-11 · check-in free text available
2022-12-04
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-12-11
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-12-19
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-12-27
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2023-01-01
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-02-19
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-05-22
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-07	Pfizer-BioNTech
2	2021-04-28	Pfizer-BioNTech
3	2021-12-30	Pfizer-BioNTech	No
4	2022-11-20	Pfizer-BioNTech	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 8 — days 1–6 daily, dose 2

2021-05-03

Systemic reaction (other): I had severe nausea (and chills) for 24 hours. It started 12 hours after my 2nd injection. I had fatigue for 2 days after that. I feel OK now though.

2021-05-04

Systemic reaction (other): I have lower back pain today but I had that before the 1st injection

Release 8 — day 14, dose 2

2021-05-12

Symptoms: I had an HSV1 outbreak. I think I may have been fighting that since before the first vaccine dose. I had backache and fatigue a couple days before the first dose. I'd only had one other outbreak since 2008 so I didn't recognize the symptoms.

Release 10 — 6 months, dose 2

2021-10-27

Symptoms: Yesterday I woke with pain on inhale, that lasted all day but was gone this morning.

Release 10 — days 1–6 daily, dose 3

2022-01-05

Systemic reaction (other): It's been a week since I had my shot so most of the symptoms are gone.

Release 10 — day 7, dose 3

2022-01-06

Systemic reaction (other): I was very sick for 2 days starting 6 hours after the shot.

Release 11 — 3 months, dose 3

2022-03-31

Symptoms: I believe I've been experiencing Autonomic neuropathy. It became serious on approx 2/11/22. It seems a bit better now but I have an appointment next week with my new clinic. I moved to a new county mid Feb and haven't been able to get an appointment. cut off by CDC

Healthcare visit (other): Still waiting

Release 12 — 6 months, dose 3

2022-06-30

Symptoms: I had shortness of breath, fatigue and heart arrythmia.

Release 12 — days 1–6 daily, dose 4

2022-11-21

Systemic reaction (other): sleeplessness

2022-11-24

Systemic reaction (other): dry bloody nose

2022-11-26

Systemic reaction (other): dry bloody nose this morning

Release 12 — day 7, dose 4

2022-11-27

Systemic reaction (other): dry bloody nose this morning

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	Unevaluable event	·	·	✓
SD	Arrhythmia	·	·	✓
SD	Back pain	✓	✓	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Painful respiration	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Unevaluable event	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Back pain	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Cough	·	·	✓
SRO	Dry mouth	·	·	✓
SRO	Dry throat	·	·	✓
SRO	Epistaxis	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Insomnia	·	·	✓
SRO	Malaise	·	·	✓
SRO	Nasal dryness	·	·	✓
SRO	Nausea	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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