4GN-92184-00579

Timeline

1. 2021-01-04
   Registered in v-safe
2. 2021-01-04
   Dose 1 — Pfizer-BioNTech
3. 2021-01-04
   Health check-in — day 0, dose 1

   Feeling: Fair · Site: Pain · Nausea

   Adult check-in
4. 2021-01-06
   Survey response — days 1–6 daily, dose 1

   MedDRA: Contusion, Dizziness, Injected limb mobility decreased, Injection site bruising, Injection site pain, Injection site swelling, Nausea, Pain in extremity, Pre-existing disease — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

   Free text: Date vaccine was given 01/04/2021 by healthcare professional BSC in Southfield. Name:(b)(6) DOB:(b)(6) White Female Non Pregnant Prescriptions: Zoloft, Xanax, Pepcid, Levothyroxin, Vaccine info: COVID-19 Pfizer 0.3ML lOT#: EK9231 Left upper arm Date & Time: 01/04/2021 approx: 11:00am (b)(6) Date & Time adverse event(s) started: 2hr later Symptoms and out come of the adverse event(s): Nausous, dizzy that lasted about 15 mins my left arm was sore. Within 3 hours I was home took a look at my area where the shot was given because my are was so sore. I found it to be swollen and very bruised 1/2 down my arm. ILLNESS CHRONIC: Reflux, diverticulitis, IBS, Fatigue, Depression, Anxiety & Panic attacks, 2wks post surgery for Gallbladder removal (chronic Cholecystitis) On 01/05/2021 while at work I found it difficult to raise my left arm above my shoulder. The bruise is now 1/2 way down my upper arm & I have a tiny other bruise where the injection site is. I just wanted someone to know. Today 01/06/2021 my left arm is sore to the touch & I have regular use of my left arm and no other symptoms. Thank you (b)(6)

   MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
5. 2021-01-07
   Health check-in — days 1–6 daily, dose 1

   Feeling: Fair · Site: Pain · Headache, Muscle or body aches

   Adult check-in
6. 2021-01-09
   Health check-in — days 1–6 daily, dose 1

   Feeling: Good · Fatigue or tiredness

   Adult check-in
7. 2021-01-10
   Survey response — days 1–6 daily, dose 1

   MedDRA: Dizziness — Feeling: Good · Fatigue or tiredness

   Free text: Dizzy

   MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
8. 2021-01-11
   Survey response — day 7, dose 1

   MedDRA: Dizziness — Feeling: Good · Headache

   Free text: Dizzy

   MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
9. 2021-01-18
   Survey response — day 14, dose 1

   MedDRA: Decreased appetite, Headache, Nausea — Feeling: Good

   Free text: Lack of appetite a little nauseous with headache

   MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
10. 2021-01-25
    Dose 2 — Pfizer-BioNTech
11. 2021-07-26
    Survey response — 6 months, dose 2

    MedDRA: Abdominal discomfort, Fatigue, Insomnia, Pre-existing disease, Pyrexia, Restlessness, Urinary incontinence — Feeling: Good

    Free text: Fatigue,low grade fever on & off, upset stomach, not sleeping, increased urine incontinence, restless

    MedDRA releases: 2021-09,2024-11 · check-in free text available
12. 2022-01-25
    Survey response — 12 months, dose 2

    MedDRA: Fatigue, Incontinence, Insomnia, Pyrexia, Vertigo — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

    Free text: Increased fatigue, not sleeping, incontinence, vertigo, slight low grade fevers on & off

    MedDRA releases: 2024-11 · check-in free text available
13. 2022-01-25
    Report sent to call center — 12 months, dose 2

    Be unable to work or attend school · Get care from a doctor or other healthcare professional

    Outpatient clinic or urgent care clinic visit · 1 call case(s)
14. 2022-01-28
    Call 1 — Requested Callback
15. 2022-01-28
    Callback requested for

    03:30PM ET
16. 2022-01-28
    Call successful

    Participant prefers to complete VAERS report online