4T8-21981-14616

3 vaccinations 15 coded responses 23 check-ins 15 free-text entries 6 call cases

Sex: Male
Age at first dose: 56-60
ZIP prefix: 330 / FL
Registered: 2021-04-21

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

2021-04-21
Registered in v-safe
2021-04-21
Dose 1 — Pfizer-BioNTech
2021-04-21
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-22
Survey response — days 1–6 daily, dose 1
MedDRA: Eye irritation, Nasopharyngitis, Pain, Self-medication — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Eyes are burning constantly and sinuses feel as though I have a cold. I've been taking Alka-Seltzer cold medicine several times today and also Tylenol and ibuprofen for the aches and pains.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Since I have OCD I am already worried about my second appointment next month because if it really is worse than this one to me that has to be complete hell! I will probably have to lay in bed for 2 days at least.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Fair · Site: Pain, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-26
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-28
Survey response — day 7, dose 1
MedDRA: Dizziness — Feeling: Poor · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Severe dizziness similar to motion sickness anytime I turn my head or lean and any direction my body wants to fall that direction.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Survey response — day 14, dose 1
MedDRA: Dizziness, Fall — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Severe dizziness from time to time especially when I look up or down and left or right almost to the point of falling down several times.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Dose 2 — Pfizer-BioNTech
2021-05-12
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-05-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-14
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Fall, Rash, Rash pruritic, Skin lesion, Skin weeping — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: I have developed a very bad rash on the opposite forearm which even has open holes in my skin, oozing clear liquid and strong itching. Also my legs have a superficial rash. Also as with the first shot; After looking up, I became so dizzy today that I actually fell down but caught myself with my hands.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Survey response — days 1–6 daily, dose 2
MedDRA: Blister, Dizziness, Rash, Somnolence — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: I get dizzy easily and have almost falling down several times in the last 24 hours! The rash on my right arm between Elbow and my wrist has gotten the much worse! I have never had anything and 60 years that it's just as much as it does. It is oozing clear liquid and as hose that go into the deeper layers of my skin! Also I am extremely sleepy to the point that yes I am watching TV it is as though I'm going into brief Comas!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease — Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: I am disabled and my caregiver, my wife, has not been taken care of my eating needs for several days now. I am living off of liquid Energy Drinks like ensure and boost!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-17
Survey response — days 1–6 daily, dose 2
MedDRA: Office visit — Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: In-person visit with my primary physician. To discuss all aspects related to the vaccine, my lack of a good diet and poor treatment by my other family members! Along with all of the health issues that I'm experiencing.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-17
Report sent to call center — days 1–6 daily, dose 2
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)
2021-05-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-19
Health check-in — day 7, dose 2
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-26
Survey response — day 14, dose 2
MedDRA: Abscess, Abscess neck, Rash, Stomatitis — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: I have deep scabs rash on right arm sores in my mouth abscess on the back of my head and neck and a Ross or on my face just below my lower lip.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Survey response — day 21, dose 2
MedDRA: Haemorrhage, Office visit, Pain in extremity, Pruritus, Rash — Feeling: Fair · 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: The rash and sores on my right arm from my hand to my elbow have gotten a whole lot worse, nothing helps. I've tried hand lotion, antibacterial ointment, cortisone cream. I wake up everyday, it changes; gets worse. Itches, hurts and bleeds!!! · Healthcare visit (other): Primary Doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Report sent to call center — day 21, dose 2
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)
2021-06-09
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-06-16
Survey response — day 35, dose 2
MedDRA: Blister, Erythema, Haemorrhage, Medical counselling, Office visit, Rash, Rash vesicular, Scab, Skin haemorrhage, Skin weeping — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Extremely horrible and deep oozing and scab RASH on my right forearm with blisters, bleeding, scabs and choosing a mixture of clear liquid and blood! The top of my left forearm is red and looks like blood spreading under the skin! · Healthcare visit (other): Primary physician visit / examination. Also telephone consultation with Dermatologist office; now attempting to get an appointment!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-16
Report sent to call center — day 35, 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)
2021-06-23
Survey response — day 42, dose 2
MedDRA: Office visit, Pain, Pain in extremity, Pruritus, Rash — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: The terrible rash, deep sores, itching, burning and pain continue to become more and more extreme and now there are a few sores on my left arm also from the elbow to the wrist! Please have someone contact me... Thank you. · Healthcare visit (other): As of yet I have been unable to go to a dermatologist because it is very difficult to find one that will accept my Medicare Advantage plan!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-23
Report sent to call center — day 42, 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)
2021-07-01
Call 1 — Left Voicemail
2021-08-11
Survey response — 3 months, dose 2
MedDRA: Blister, Haemorrhage, Illness, Impaired healing, Office visit, Pruritus, Rash, Scab — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: The horrible, blistering, scabbing rash illness on my right forearm is now also on my left forearm! Incredible itching non stop bleeding and no sign of healing at all! · Healthcare visit (other): Primary physician. He cannot diagnose it!

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-11
Report sent to call center — 3 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)
2021-08-17
Call 1 — Left Voicemail
2021-09-01
Dose 3 — Pfizer-BioNTech
2021-11-12
Survey response — 6 months, dose 2
MedDRA: General physical health deterioration, Immune system disorder, Office visit, Skin lesion, Stomatitis, Viral infection — Feeling: Poor · Be unable to work or attend school, 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: My overall health and immune system have gone downhill dramatically!. Viral clusters in my mouth taking Acyclovir and Prednisone (just starting my second round) now. Skin lesions on forearms; still UNDIAGNOSED!!! AND MORE!!! · Healthcare visit (other): My general practitioner.

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-15
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-21	Pfizer-BioNTech
2	2021-05-12	Pfizer-BioNTech
3	2021-09-01	Pfizer-BioNTech	No

Call center

6 call center cases

6 successful

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-22

Systemic reaction (other): Eyes are burning constantly and sinuses feel as though I have a cold. I've been taking Alka-Seltzer cold medicine several times today and also Tylenol and ibuprofen for the aches and pains.

2021-04-23

Systemic reaction (other): Since I have OCD I am already worried about my second appointment next month because if it really is worse than this one to me that has to be complete hell! I will probably have to lay in bed for 2 days at least.

2021-04-24

Systemic reaction (other): No

Release 8 — day 7, dose 1

2021-04-28

Systemic reaction (other): Severe dizziness similar to motion sickness anytime I turn my head or lean and any direction my body wants to fall that direction.

Release 8 — day 14, dose 1

2021-05-05

Symptoms: Severe dizziness from time to time especially when I look up or down and left or right almost to the point of falling down several times.

Release 8 — days 1–6 daily, dose 2

2021-05-14

Systemic reaction (other): I have developed a very bad rash on the opposite forearm which even has open holes in my skin, oozing clear liquid and strong itching. Also my legs have a superficial rash. Also as with the first shot; After looking up, I became so dizzy today that I actually fell down but caught myself with my hands.

2021-05-15

Systemic reaction (other): I get dizzy easily and have almost falling down several times in the last 24 hours! The rash on my right arm between Elbow and my wrist has gotten the much worse! I have never had anything and 60 years that it's just as much as it does. It is oozing clear liquid and as hose that go into the deeper layers of my skin! Also I am extremely sleepy to the point that yes I am watching TV it is as though I'm going into brief Comas!

2021-05-16

Systemic reaction (other): I am disabled and my caregiver, my wife, has not been taken care of my eating needs for several days now. I am living off of liquid Energy Drinks like ensure and boost!

2021-05-17

Healthcare visit (other): In-person visit with my primary physician. To discuss all aspects related to the vaccine, my lack of a good diet and poor treatment by my other family members! Along with all of the health issues that I'm experiencing.

Release 8 — day 14, dose 2

2021-05-26

Symptoms: I have deep scabs rash on right arm sores in my mouth abscess on the back of my head and neck and a Ross or on my face just below my lower lip.

Release 8 — day 21, dose 2

2021-06-02

Symptoms: The rash and sores on my right arm from my hand to my elbow have gotten a whole lot worse, nothing helps. I've tried hand lotion, antibacterial ointment, cortisone cream. I wake up everyday, it changes; gets worse. Itches, hurts and bleeds!!!

Healthcare visit (other): Primary Doctor

Release 9 — day 35, dose 2

2021-06-16

Symptoms: Extremely horrible and deep oozing and scab RASH on my right forearm with blisters, bleeding, scabs and choosing a mixture of clear liquid and blood! The top of my left forearm is red and looks like blood spreading under the skin!

Healthcare visit (other): Primary physician visit / examination. Also telephone consultation with Dermatologist office; now attempting to get an appointment!

Release 9 — day 42, dose 2

2021-06-23

Symptoms: The terrible rash, deep sores, itching, burning and pain continue to become more and more extreme and now there are a few sores on my left arm also from the elbow to the wrist! Please have someone contact me... Thank you.

Healthcare visit (other): As of yet I have been unable to go to a dermatologist because it is very difficult to find one that will accept my Medicare Advantage plan!

Release 9 — 3 months, dose 2

2021-08-11

Symptoms: The horrible, blistering, scabbing rash illness on my right forearm is now also on my left forearm! Incredible itching non stop bleeding and no sign of healing at all!

Healthcare visit (other): Primary physician. He cannot diagnose it!

Release 10 — 6 months, dose 2

2021-11-12

Symptoms: My overall health and immune system have gone downhill dramatically!. Viral clusters in my mouth taking Acyclovir and Prednisone (just starting my second round) now. Skin lesions on forearms; still UNDIAGNOSED!!! AND MORE!!!

Healthcare visit (other): My general practitioner.

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	Abscess	✓	✓	✓
SD	Abscess neck	✓	✓	✓
SD	Blister	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Erythema	·	·	✓
SD	Fall	✓	✓	✓
SD	General physical health deterioration	·	·	✓
SD	Haemorrhage	✓	✓	✓
SD	Illness	✓	·	✓
SD	Immune system disorder	·	·	✓
SD	Impaired healing	✓	·	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash vesicular	·	·	✓
SD	Scab	✓	✓	✓
SD	Skin haemorrhage	·	·	✓
SD	Skin lesion	·	·	✓
SD	Skin weeping	·	·	✓
SD	Stomatitis	✓	✓	✓
SD	Viral infection	·	·	✓
SRO	Blister	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Eye irritation	✓	✓	✓
SRO	Fall	✓	✓	✓
SRO	Nasopharyngitis	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Rash pruritic	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Skin lesion	✓	✓	✓
SRO	Skin weeping	✓	✓	✓
SRO	Somnolence	✓	✓	✓

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