429-16349-41140
5 vaccinations
6 coded responses
46 check-ins
6 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 931 / CA
- Registered
- 2021-02-20
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-19
Dose 1 — Pfizer-BioNTech
-
2021-02-20
Registered in v-safe
-
2021-02-20
Survey response — days 1–6 daily, dose 1MedDRA: Rhinorrhoea — Feeling: Fair · Site: Pain · Fatigue or tirednessFree text: Runny NoseMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-21
- 2021-02-23
- 2021-02-25
- 2021-02-26
- 2021-03-05
-
2021-03-12
Dose 2 — Pfizer-BioNTech
- 2021-03-12
- 2021-03-14
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-26
- 2021-04-02
- 2021-04-09
- 2021-04-16
- 2021-04-25
-
2021-06-13
Survey response — 3 months, dose 2MedDRA: Diverticulitis — Feeling: Poor · Be unable to do your normal daily activitiesFree text: DiverticulitisMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-09-12
-
2021-09-28
Dose 3 — Pfizer-BioNTech
-
2021-09-30
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Redness, Swelling · NoneAdult check-in
-
2021-10-01
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Redness, Swelling, Itching · NoneAdult check-in
-
2021-10-02
Survey response — days 1–6 daily, dose 3MedDRA: Limb discomfort — Feeling: Good · Site: Pain, ItchingFree text: No - except arm discomfort is less each day. Almost gone.MedDRA releases: 2024-11 · check-in free text available
-
2021-10-03
Survey response — days 1–6 daily, dose 3MedDRA: Pain in extremity — Feeling: Good · Site: PainFree text: Arm pain minimalMedDRA releases: 2024-11 · check-in free text available
- 2021-10-04
- 2021-10-05
- 2021-10-12
- 2021-10-21
- 2021-11-02
- 2021-11-09
- 2021-12-28
- 2022-03-29
-
2022-04-06
Dose 4 — Pfizer-BioNTech
- 2022-05-14
- 2022-05-18
- 2022-07-08
- 2022-10-07
-
2022-10-22
Dose 5 — ModernaCo-administered: Flu
- 2022-10-24
- 2022-10-27
- 2022-10-29
-
2022-11-05
Survey response — day 14, dose 5MedDRA: Dehydration, Emergency care, Syncope — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: On Friday, October 28, I fainted and was taken to the ER by ambulance. This was apparently caused by dehydration. This had never happened to me before. I was treated with IV fluids, had 2 EKG's which were normal & released about 4 hours later.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-05
Report sent to call center — day 14, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2022-11-07
-
2022-11-07
Call successfulCompleted over the phone
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2022-11-12
Survey response — day 21, dose 5MedDRA: Fibrin D dimer increased, Syncope, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: After having bloodwork done due to a fainting spell reported last week i had an abnormally high D Dimer result which is a test for blood clots. Consequently i had a Ct chest PE with contrast scan, the result was negative, no pulmonary embolism. · Healthcare visit (other): Ct ScanMedDRA releases: 2024-11 · check-in free text available
-
2022-11-12
Report sent to call center — day 21, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2022-11-14
-
2022-11-16
Callback requested for12:00PM ET
-
2022-11-16
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-11-21
- 2022-11-26
- 2022-12-03
- 2023-01-21
- 2023-04-23
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-19 | Pfizer-BioNTech | |
| 2 | 2021-03-12 | Pfizer-BioNTech | |
| 3 | 2021-09-28 | Pfizer-BioNTech | No |
| 4 | 2022-04-06 | Pfizer-BioNTech | No |
| 5 | 2022-10-22 | Moderna | Flu |
Call center
2 call center cases
2 successful
VAERS report filed, before or during a call: 1
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Runny Nose
Release 9 — 3 months, dose 2
Symptoms: Diverticulitis
Release 9 — days 1–6 daily, dose 3
Systemic reaction (other): No - except arm discomfort is less each day. Almost gone.
Systemic reaction (other): Arm pain minimal
Release 12 — day 14, dose 5
Symptoms: On Friday, October 28, I fainted and was taken to the ER by ambulance. This was apparently caused by dehydration. This had never happened to me before. I was treated with IV fluids, had 2 EKG's which were normal & released about 4 hours later.
Release 12 — day 21, dose 5
Symptoms: After having bloodwork done due to a fainting spell reported last week i had an abnormally high D Dimer result which is a test for blood clots. Consequently i had a Ct chest PE with contrast scan, the result was negative, no pulmonary embolism.
Healthcare visit (other): Ct Scan
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 | Dehydration | · | · | ✓ |
| SD | Diverticulitis | ✓ | ✓ | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Fibrin D dimer increased | · | · | ✓ |
| SD | Syncope | · | · | ✓ |
| SRO | Limb discomfort | · | · | ✓ |
| SRO | Pain in extremity | · | · | ✓ |
| SRO | Rhinorrhoea | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release