4LF-11070-53039

1 vaccination 8 coded responses 9 check-ins 8 free-text entries 6 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 775 / TX
Registered: 2021-01-09

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

2021-01-03
Dose 1 — Pfizer-BioNTech
2021-01-09
Registered in v-safe
2021-01-10
Survey response — day 7, dose 1
MedDRA: SARS-CoV-2 test positive — Feeling: Fair · Fatigue or tiredness

Free text: Very important, i want to report to the CDC i received the covid vaccine on January 3, 2021 on Jan 8th i was covid positive in a preop test

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Survey response — day 14, dose 1
MedDRA: Abdominal pain, Decreased appetite, Fatigue, Pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Lack of appetite , general fatigue, increased pain level

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-24
Survey response — day 21, dose 1
MedDRA: Hospitalisation, Sepsis, Urinary tract infection — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Developed UTI that turned sepsis Currently hospitalized

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
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)
2021-01-31
Survey response — day 28, dose 1
MedDRA: Hospitalisation, SARS-CoV-2 test false positive, Sepsis, Urinary tract infection — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Hospitalized for false positive covid test. Turned out to be UTI that went sepsis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Report sent to call center — day 28, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-07
Survey response — day 35, dose 1
MedDRA: Hospitalisation, Sepsis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: I have a sepsis (ecoli) infection that was misdiagnosed as covid, due to false positives from the rapid test. I believe that the vaccine caused the false tests. Would life to discuss this with the CDC · Healthcare visit (other): Hospitalization has almost been 3 week further duration unknown

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Report sent to call center — day 35, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-14
Health check-in — day 42, dose 1
Feeling: Poor

Adult check-in
2021-04-04
Survey response — 3 months, dose 1
MedDRA: Hospitalisation, SARS-CoV-2 test positive — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Had first Pfizer vaccine on 1/4/2021. I just got out of the hospital after a 2.5 month stay. I kept testing positive for covid with the rapid test. Blood cultures taken twice showed i not only didn't have covid but never had it. I tried to contact u

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-01
Call successful
Completed over the phone
2021-07-04
Survey response — 6 months, dose 1
MedDRA: Blood glucose fluctuation, Blood pressure fluctuation, Hospitalisation — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: I have been experiencing significant fluxes in blood pressure and sugar · Healthcare visit (other): I am on my third and final week of inpatient rehab and acute medical care

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-04
Report sent to call center — 6 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-09
Call 1 — Left Voicemail
2021-07-09
Callback requested for
PM
2021-07-09
Call successful
Completed over the phone
2022-01-07
Survey response — 12 months, dose 1
MedDRA: Asthenia, Decreased appetite, Fatigue — 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

Free text: Loss of appetite loss of strength tired

MedDRA releases: 2024-11 · check-in free text available
2022-01-07
Report sent to call center — 12 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-01-17
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-03	Pfizer-BioNTech

Call center

6 call center cases

4 successful · 1 unsuccessful · 1 priority 2/3 (triaged and no follow up)

VAERS report filed, before or during a call: 4

See the call center timeline

Free text

Release 1 — day 7, dose 1

2021-01-10

Systemic reaction (other): Very important, i want to report to the CDC i received the covid vaccine on January 3, 2021 on Jan 8th i was covid positive in a preop test

Release 2 — day 14, dose 1

2021-01-18

Symptoms: Lack of appetite , general fatigue, increased pain level

Release 2 — day 21, dose 1

2021-01-24

Symptoms: Developed UTI that turned sepsis Currently hospitalized

Release 3 — day 28, dose 1

2021-01-31

Symptoms: Hospitalized for false positive covid test. Turned out to be UTI that went sepsis

Release 3 — day 35, dose 1

2021-02-07

Symptoms: I have a sepsis (ecoli) infection that was misdiagnosed as covid, due to false positives from the rapid test. I believe that the vaccine caused the false tests. Would life to discuss this with the CDC

Healthcare visit (other): Hospitalization has almost been 3 week further duration unknown

Release 6 — 3 months, dose 1

2021-04-04

Symptoms: Had first Pfizer vaccine on 1/4/2021. I just got out of the hospital after a 2.5 month stay. I kept testing positive for covid with the rapid test. Blood cultures taken twice showed i not only didn't have covid but never had it. I tried to contact u cut off by CDC

Release 9 — 6 months, dose 1

2021-07-04

Symptoms: I have been experiencing significant fluxes in blood pressure and sugar

Healthcare visit (other): I am on my third and final week of inpatient rehab and acute medical care

Release 10 — 12 months, dose 1

2022-01-07

Symptoms: Loss of appetite loss of strength tired

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	Hospitalisation	✓	✓	✓
SD	Abdominal pain	✓	✓	✓
SD	Asthenia	·	·	✓
SD	Blood glucose fluctuation	✓	✓	✓
SD	Blood pressure fluctuation	✓	✓	✓
SD	Decreased appetite	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Pain	✓	✓	✓
SD	SARS-CoV-2 test false positive	✓	✓	✓
SD	SARS-CoV-2 test positive	✓	✓	✓
SD	Sepsis	✓	✓	✓
SD	Urinary tract infection	✓	✓	✓
SRO	COVID-19	○	○	○
SRO	SARS-CoV-2 test positive	✓	✓	✓

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