4BS-22840-25813

3 vaccinations 11 coded responses 27 check-ins 11 free-text entries 2 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 775 / TX
Registered: 2021-01-18

Relationship: Self
Race: Multiracial
Ethnicity: N/A

Timeline

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

2021-01-18
Registered in v-safe
2021-01-18
Dose 1 — Pfizer-BioNTech
2021-01-18
Survey response — day 0, dose 1
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Thinking slower, memory circuit requires more effort.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Migraine — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Headache turned intoa real migraine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Nausea

Adult check-in
2021-01-23
Survey response — days 1–6 daily, dose 1
MedDRA: Memory impairment — Feeling: Fair

Free text: Memory foggy. Slow thinking in games online. Doubleing back on myself like deja vu think

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal discomfort, Nausea, Pain in extremity — Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Stomach upset, nausea only rt after i eat. Left arm still sote but better ea day as longas

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-01
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-09
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-15
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-02-24
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-03-01
Health check-in — day 42, dose 1
Feeling: Fair

Adult check-in
2021-03-02
Dose 2 — Pfizer-BioNTech
2021-03-02
Survey response — day 0, dose 2
MedDRA: Dizziness, Dysgeusia, Headache, Immediate post-injection reaction, Pain — Feeling: Poor · Site: Pain, Redness · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: I tasted a metallic like taste in my mouth rught after the 2shot. I was dizzy -achy all day afterwards. Bad headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Diarrhoea, Dysgeusia, Headache — Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Metallic taste in my mouth is gone. Diaherra all night & a heafsche.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Nausea

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Nausea, Diarrhea

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-09
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-18
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-23
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-13
Survey response — day 42, dose 2
MedDRA: Dyspnoea — Feeling: Fair

Free text: Shortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-01
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-31
Survey response — 6 months, dose 2
MedDRA: Physiotherapy, Rotator cuff syndrome — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Rt shpulder tendonitis. No sirgery on ba · Healthcare visit (other): Phyiscal therpy

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-31
Report sent to call center — 6 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

1 call case(s)
2021-09-03
Call successful
Does not wish to fill out VAERS report
2021-12-07
Dose 3 — Moderna
2022-03-02
Survey response — 12 months, dose 2
MedDRA: Asthenia, Blood glucose increased, Blood pressure abnormal, Dyspnoea, Exercise tolerance decreased, Headache, Sleep disorder, Vision blurred — Feeling: Fair · Be unable to do your normal daily activities

Free text: Breathlessness, weakness in endurance. Headaches. Sleeping problems, feeling low with no energy. I don't think my blood pressure is as well controlled by the meds. Glucose numbers up in avg over the last 14/15months by 10/15%. Blurry vision.IDKnow

MedDRA releases: 2024-11 · check-in free text available
2022-06-07
Survey response — 6 months, dose 3
MedDRA: Arthralgia, Dyspnoea, Fatigue, Headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: easily Fatigued, breathless just walking a couple blocks. More severe pain with joint problems. Headaches in the mornings.

MedDRA releases: 2024-11 · check-in free text available
2022-12-09
Survey response — 12 months, dose 3
MedDRA: Brain fog, Fatigue, Nasopharyngitis, SARS-CoV-2 test negative, Sinusitis — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I had a cold or sinus infection. I used a Home covid test kit and the result was neg. Im very fatigued and wake in the mornings foggy headed since my bivalent booster shot in Oct. 2022.

MedDRA releases: 2024-11 · check-in free text available
2022-12-09
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-12-13
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-18	Pfizer-BioNTech
2	2021-03-02	Pfizer-BioNTech
3	2021-12-07	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 2 — day 0, dose 1

2021-01-18

Systemic reaction (other): Thinking slower, memory circuit requires more effort.

Release 2 — days 1–6 daily, dose 1

2021-01-19

Systemic reaction (other): Headache turned intoa real migraine.

2021-01-23

Systemic reaction (other): Memory foggy. Slow thinking in games online. Doubleing back on myself like deja vu think

2021-01-24

Systemic reaction (other): Stomach upset, nausea only rt after i eat. Left arm still sote but better ea day as longas

Release 4 — day 0, dose 2

2021-03-02

Systemic reaction (other): I tasted a metallic like taste in my mouth rught after the 2shot. I was dizzy -achy all day afterwards. Bad headache

Release 5 — days 1–6 daily, dose 2

2021-03-03

Systemic reaction (other): Metallic taste in my mouth is gone. Diaherra all night & a heafsche.

Release 7 — day 42, dose 2

2021-04-13

Symptoms: Shortness of breath

Release 9 — 6 months, dose 2

2021-08-31

Symptoms: Rt shpulder tendonitis. No sirgery on ba

Healthcare visit (other): Phyiscal therpy

Release 11 — 12 months, dose 2

2022-03-02

Symptoms: Breathlessness, weakness in endurance. Headaches. Sleeping problems, feeling low with no energy. I don't think my blood pressure is as well controlled by the meds. Glucose numbers up in avg over the last 14/15months by 10/15%. Blurry vision.IDKnow

Release 11 — 6 months, dose 3

2022-06-07

Symptoms: easily Fatigued, breathless just walking a couple blocks. More severe pain with joint problems. Headaches in the mornings.

Release 12 — 12 months, dose 3

2022-12-09

Symptoms: I had a cold or sinus infection. I used a Home covid test kit and the result was neg. Im very fatigued and wake in the mornings foggy headed since my bivalent booster shot in Oct. 2022.

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	Physiotherapy	✓	·	✓
SD	Arthralgia	·	·	✓
SD	Asthenia	·	·	✓
SD	Blood glucose increased	·	·	✓
SD	Blood pressure abnormal	·	·	✓
SD	Brain fog	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Exercise tolerance decreased	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Rotator cuff syndrome	✓	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinusitis	·	·	✓
SD	Sleep disorder	·	·	✓
SD	Vision blurred	·	·	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dysgeusia	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Memory impairment	✓	✓	✓
SRO	Migraine	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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