4LQ-18193-15855

3 vaccinations 7 coded responses 16 check-ins 7 free-text entries 4 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 300 / GA
Registered: 2021-11-04

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

Registered dependents

9GG-21806-95377 Child or adolescent in my care · Female · 2021-11-04

BJL-13825-40918 Child or adolescent in my care · Male · 2021-11-04

Timeline

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

2021-03-02
Dose 1 — Pfizer-BioNTech
2021-03-23
Dose 2 — Pfizer-BioNTech
2021-11-04
Registered in v-safe
2021-11-14
Dose 3 — Pfizer-BioNTech
2021-11-14
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-15
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-11-16
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-11-17
Survey response — days 1–6 daily, dose 3
MedDRA: Tinnitus — Feeling: Good

Free text: Tinnitus

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Survey response — days 1–6 daily, dose 3
MedDRA: Tinnitus — Feeling: Good

Free text: Tinnitus

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-20
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-22
Survey response — day 7, dose 3
MedDRA: Tinnitus — Feeling: Good

Free text: Tinnitus

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-05
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-12
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-19
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-26
Survey response — day 42, dose 3
MedDRA: Pain in extremity, Tinnitus — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Possible endometriosis Leg pain/soreness Tinnitus

MedDRA releases: 2024-11 · check-in free text available
2021-12-26
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-27
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-02-14
Survey response — 3 months, dose 3
MedDRA: Endometriosis, Tinnitus — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Tinnitus Endometriosis

MedDRA releases: 2024-11 · check-in free text available
2022-02-14
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-15
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-05-15
Survey response — 6 months, dose 3
MedDRA: Alopecia, Gastrooesophageal reflux disease, Headache, Pain in extremity, Weight decreased — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Reflux, weight loss, headaches, leg pain, hair loss, potential diagnosis of endometriosis that I've never suffered from before

MedDRA releases: 2024-11 · check-in free text available
2022-05-15
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-16
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-14
Survey response — 12 months, dose 3
MedDRA: Abdominal pain lower, Atypical migraine, Back pain, Exploratory operation, Gastrooesophageal reflux disease, Headache, Laparoscopic surgery, Ophthalmic migraine, Pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Hospitalization

Free text: Symptoms: Headaches, atypical migraine, ocular migraine (can't remember if I mentioned in the past) Persistent lower abdominal/lower back pain, reflux · Healthcare visit (other): Exploratory laparoscopic surgery to explain reflux & pain

MedDRA releases: 2024-11 · check-in free text available
2022-11-14
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 · Hospitalization · 1 call case(s)
2022-11-15
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-02	Pfizer-BioNTech	No
2	2021-03-23	Pfizer-BioNTech	No
3	2021-11-14	Pfizer-BioNTech	No

Call center

4 call center cases

3 successful · 1 unsuccessful

VAERS report filed, before or during a call: 2

See the call center timeline

Free text

Release 10 — days 1–6 daily, dose 3

2021-11-17

Systemic reaction (other): Tinnitus

2021-11-18

Systemic reaction (other): Tinnitus

Release 10 — day 7, dose 3

2021-11-22

Systemic reaction (other): Tinnitus

Release 10 — day 42, dose 3

2021-12-26

Symptoms: Possible endometriosis Leg pain/soreness Tinnitus

Release 11 — 3 months, dose 3

2022-02-14

Symptoms: Tinnitus Endometriosis

Release 11 — 6 months, dose 3

2022-05-15

Symptoms: Reflux, weight loss, headaches, leg pain, hair loss, potential diagnosis of endometriosis that I've never suffered from before

Release 12 — 12 months, dose 3

2022-11-14

Symptoms: Headaches, atypical migraine, ocular migraine (can't remember if I mentioned in the past) Persistent lower abdominal/lower back pain, reflux

Healthcare visit (other): Exploratory laparoscopic surgery to explain reflux & pain

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	Exploratory operation	·	·	✓
HCVO	Gastrooesophageal reflux disease	·	·	✓
HCVO	Laparoscopic surgery	·	·	✓
HCVO	Pain	·	·	✓
SD	Abdominal pain lower	·	·	✓
SD	Alopecia	·	·	✓
SD	Atypical migraine	·	·	✓
SD	Back pain	·	·	✓
SD	Endometriosis	·	·	✓
SD	Gastrooesophageal reflux disease	·	·	✓
SD	Headache	·	·	✓
SD	Ophthalmic migraine	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Tinnitus	·	·	✓
SD	Weight decreased	·	·	✓
SRO	Tinnitus	·	·	✓

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