4GB-23727-12508

1 vaccination 7 coded responses 11 check-ins 7 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 967 / HI
Registered: 2021-01-25

Relationship: Self
Race: Other
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-22
Dose 1 — Pfizer-BioNTech
2021-01-25
Registered in v-safe
2021-01-25
Survey response — days 1–6 daily, dose 1
MedDRA: Mental disorder, Nervous system disorder — Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Mild central nervous system effects. Psychoactive experiences

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Chills, Headache, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Chills, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-01-29
Survey response — day 7, dose 1
MedDRA: Confusional state — Feeling: Good · Chills, Headache, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site

Free text: Cognitive confusion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-12
Survey response — day 21, dose 1
MedDRA: Confusional state, Fatigue, Headache, Office visit, Rash — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Cognitive confusion similar to dementia. Headaches. Exhaustion. Skin rash. · Healthcare visit (other): Visit with two of my primary care providers

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-19
Survey response — day 28, dose 1
MedDRA: Asthma, Chest pain, Dyspnoea, Fatigue, Headache, Medical counselling, Office visit — Feeling: Poor · Be unable to work, 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: Symptoms: Severe pain in chest. At cardiologist now. Serious asthma. Headache. Fatigue. Shortness of breath Wondering about autoimmune reaction · Healthcare visit (other): Conference with primary care physicians and made decision to put off second vaccination for a couple of weeks.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Report sent to call center — day 28, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-26
Survey response — day 35, dose 1
MedDRA: Asthma, Muscle spasms — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Continue with asthma and severe muscle spasms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Report sent to call center — day 35, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-05
Survey response — day 42, dose 1
MedDRA: Asthma, Brief resolved unexplained event, Immunisation reaction, Office visit, Pre-existing disease — Feeling: Fair · Be unable to work, 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, Emergency room or emergency department visit

Free text: Life threatening asthma attacks. Allergist has written a letter that I not get any more of the RNA vaccines. Instead get one shot of the traditional vaccine from Johnson and Johnson.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Report sent to call center — day 42, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-24
Survey response — 3 months, dose 1
MedDRA: Brief resolved unexplained event, Cognitive disorder, Respiratory disorder — Feeling: Fair · 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

Free text: I continue to have respiratory problems. I am also having cognitive issues. I am very concerned that no one from the CDC has contacted me about the life threatening respiratory condition I experienced.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Report sent to call center — 3 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-23
Health check-in — 6 months, dose 1
Feeling: Fair

Adult check-in
2021-07-28
Call 1 — Left Voicemail
2021-07-29
Call 2 — Left Voicemail
2021-07-29
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Pfizer-BioNTech

Call center

5 call center cases

5 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-25

Systemic reaction (other): Mild central nervous system effects. Psychoactive experiences

Release 3 — day 7, dose 1

2021-01-29

Systemic reaction (other): Cognitive confusion

Release 4 — day 21, dose 1

2021-02-12

Symptoms: Cognitive confusion similar to dementia. Headaches. Exhaustion. Skin rash.

Healthcare visit (other): Visit with two of my primary care providers

Release 4 — day 28, dose 1

2021-02-19

Symptoms: Severe pain in chest. At cardiologist now. Serious asthma. Headache. Fatigue. Shortness of breath Wondering about autoimmune reaction

Healthcare visit (other): Conference with primary care physicians and made decision to put off second vaccination for a couple of weeks.

Release 4 — day 35, dose 1

2021-02-26

Symptoms: Continue with asthma and severe muscle spasms

Release 5 — day 42, dose 1

2021-03-05

Symptoms: Life threatening asthma attacks. Allergist has written a letter that I not get any more of the RNA vaccines. Instead get one shot of the traditional vaccine from Johnson and Johnson.

Release 7 — 3 months, dose 1

2021-04-24

Symptoms: I continue to have respiratory problems. I am also having cognitive issues. I am very concerned that no one from the CDC has contacted me about the life threatening respiratory condition I experienced.

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	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Asthma	✓	✓	✓
SD	Brief resolved unexplained event	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Cognitive disorder	✓	✓	✓
SD	Confusional state	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Immunisation reaction	✓	·	✓
SD	Muscle spasms	✓	✓	✓
SD	Office visit	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Respiratory disorder	✓	✓	✓
SRO	Confusional state	✓	✓	✓
SRO	Mental disorder	✓	✓	✓
SRO	Nervous system disorder	✓	✓	✓

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