4TM-13254-43177

5 vaccinations 12 coded responses 35 check-ins 11 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 220 / VA
Registered: 2021-03-06

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

2021-02-13
Dose 1 — Pfizer-BioNTech
2021-03-06
Registered in v-safe
2021-03-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-07
Dose 2 — Pfizer-BioNTech
2021-03-07
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Good

Free text: Nothing to report.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain · Fever

Free text: None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pruritus, Pruritus — Feeling: Good · Site: Swelling

Free text: Itchiness around the site and else where.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Pyrexia — Feeling: Good

Free text: On Monday evening I had a bout of chills and feverish feeling similar to shot 1 but it only lasted into my sleep time. On waking I felt great.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Joint pains, Rash, not including the immediate area around the injection site

Adult check-in
2021-03-14
Health check-in — day 7, dose 2
Feeling: Good · Headache, Joint pains

Adult check-in
2021-03-21
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-28
Survey response — day 21, dose 2
MedDRA: Injection site pruritus — Feeling: Good

Free text: Itching again at the site of the injections.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-18
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-06
Survey response — 3 months, dose 2
MedDRA: Abdominal distension, Abdominal pain, Flatulence — Feeling: Good

Free text: Unusual abdominal cramping, bloating and gas.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-05
Survey response — 6 months, dose 2
MedDRA: Back pain, Gastrointestinal disorder, Post procedural complication — Feeling: Good

Free text: Had some bowel problems after a colonoscopy but things seem fine now except for back pain. I would say nothing related to Covid or the vaccinations.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-28
Dose 3 — Pfizer-BioNTech
2021-10-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-03
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Joint pains, Fatigue or tiredness

Adult check-in
2021-10-04
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness — Feeling: Good

Free text: Dizziness

MedDRA releases: 2024-11 · check-in free text available
2021-10-05
Health check-in — day 7, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-10-12
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-10-20
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-10-27
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-02
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-11
Survey response — day 42, dose 3
MedDRA: Chills, Nasopharyngitis, Productive cough, Pyrexia — Feeling: Fair

Free text: Bad cough, phlegm, minor feverish nests and chills. A cold at any other time.

MedDRA releases: 2024-11 · check-in free text available
2021-12-28
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-29
Survey response — 6 months, dose 3
MedDRA: Cataract — Feeling: Good

Free text: Diagnosis of cataracts.

MedDRA releases: 2024-11 · check-in free text available
2022-04-20
Dose 4 — Pfizer-BioNTech
Co-administered: Shingles
2022-05-05
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-11
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-18
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-25
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-01
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-21
Survey response — 3 months, dose 4
MedDRA: Decreased appetite, Nausea, Productive cough, Pyrexia, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Throat irritation, Unevaluable event — Feeling: Good · 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: Symptoms: On July 2 noticed scratchy throat and increased phlegm, two at home tests one on 6/2 a second on 6/3 were negative. On July 4 I had increased symptoms including fever nausea and increasing phlegm loss of appetite. Third test was positive for Covid. · Healthcare visit (other): Herbal assslistance.

MedDRA releases: 2024-11 · check-in free text available
2022-07-21
Report sent to call center — 3 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-07-22
Call 1 — Left Voicemail
2022-07-22
Call successful
Completed over the phone
2022-09-12
Dose 5 — Pfizer-BioNTech
Co-administered: Shingles
2022-10-19
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-20
Survey response — 12 months, dose 4
MedDRA: Brain fog, Loss of personal independence in daily activities, Pain in extremity — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-20
Report sent to call center — 12 months, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-21
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-13	Pfizer-BioNTech
2	2021-03-07	Pfizer-BioNTech
3	2021-09-28	Pfizer-BioNTech	No
4	2022-04-20	Pfizer-BioNTech	Shingles
5	2022-09-12	Pfizer-BioNTech	Shingles

Call center

2 call center cases

1 successful · 1 unsuccessful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 5 — day 0, dose 2

2021-03-07

Systemic reaction (other): Nothing to report.

Release 5 — days 1–6 daily, dose 2

2021-03-08

Systemic reaction (other): None

2021-03-09

Systemic reaction (other): Itchiness around the site and else where.

2021-03-10

Systemic reaction (other): On Monday evening I had a bout of chills and feverish feeling similar to shot 1 but it only lasted into my sleep time. On waking I felt great.

Release 6 — day 21, dose 2

2021-03-28

Symptoms: Itching again at the site of the injections.

Release 8 — 3 months, dose 2

2021-06-06

Symptoms: Unusual abdominal cramping, bloating and gas.

Release 9 — 6 months, dose 2

2021-09-05

Symptoms: Had some bowel problems after a colonoscopy but things seem fine now except for back pain. I would say nothing related to Covid or the vaccinations.

Release 9 — days 1–6 daily, dose 3

2021-10-04

Systemic reaction (other): Dizziness

Release 10 — day 42, dose 3

2021-11-11

Symptoms: Bad cough, phlegm, minor feverish nests and chills. A cold at any other time.

Release 11 — 6 months, dose 3

2022-03-29

Symptoms: Diagnosis of cataracts.

Release 12 — 3 months, dose 4

2022-07-21

Symptoms: On July 2 noticed scratchy throat and increased phlegm, two at home tests one on 6/2 a second on 6/3 were negative. On July 4 I had increased symptoms including fever nausea and increasing phlegm loss of appetite. Third test was positive for Covid. cut off by CDC

Healthcare visit (other): Herbal assslistance.

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	Unevaluable event	·	·	✓
SD	Abdominal distension	✓	✓	✓
SD	Abdominal pain	✓	✓	✓
SD	Back pain	✓	·	✓
SD	Brain fog	·	·	✓
SD	Cataract	·	·	✓
SD	Chills	·	·	✓
SD	Decreased appetite	·	·	✓
SD	Flatulence	✓	✓	✓
SD	Gastrointestinal disorder	✓	·	✓
SD	Injection site pruritus	✓	✓	✓
SD	Loss of personal independence in daily activities	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Nausea	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Post procedural complication	✓	·	✓
SD	Productive cough	·	·	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Throat irritation	·	·	✓
SRO	Chills	✓	✓	✓
SRO	Dizziness	·	·	✓
SRO	Injection site pruritus	✓	·	✓
SRO	No adverse event	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Pyrexia	✓	✓	✓

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