4UN-27437-15748

4 vaccinations 12 coded responses 27 check-ins 12 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 786 / TX
Registered: 2021-04-28

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

Registered dependents

ZSG-18872-42929 Child or adolescent in my care · Female · 2022-07-02

Timeline

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

2021-04-13
Dose 1 — Pfizer-BioNTech
2021-04-28
Registered in v-safe
2021-04-28
Survey response — day 14, dose 1
MedDRA: Urticaria — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Hives that began 4/26 for with no known cause.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-04
Survey response — day 21, dose 1
MedDRA: Urticaria — Feeling: Good

Free text: Hives

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Dose 2 — Pfizer-BioNTech
2021-05-12
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain

Free text: Swollen lymph nodes around collar bone on side I received shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain

Free text: Swollen nodes around collar bone on side of injection.

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: Lymphadenopathy — Feeling: Good · Site: Pain

Free text: Swollen lymph node on side of injection

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: Lymphadenopathy — Feeling: Good

Free text: Swelling of lymph nodes under clavicle same side as vaccination

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: Lymphadenopathy — Feeling: Good

Free text: Swollen lymph node on side of injection, under clavicle

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Survey response — day 7, dose 2
MedDRA: Lymphadenopathy — Feeling: Good

Free text: Swollen lymph node under clavicle on injection side

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-01
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-08
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-22
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-10
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-11-09
Survey response — 6 months, dose 2
MedDRA: Acne, Hormone level abnormal — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Acne/hormonal fluctuations

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-11-10
Call successful
Does not wish to fill out VAERS report
2021-12-10
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2022-05-11
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-10-26
Dose 4 — Moderna
2022-10-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-10-31
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-11-01
Survey response — days 1–6 daily, dose 4
MedDRA: Aphthous ulcer — Feeling: Good

Free text: Canker sore

MedDRA releases: 2024-11 · check-in free text available
2022-11-02
Survey response — day 7, dose 4
MedDRA: Aphthous ulcer — Feeling: Good

Free text: Canker sore

MedDRA releases: 2024-11 · check-in free text available
2022-11-09
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-11-23
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-30
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-07
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-01-25
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-04-28
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-13	Pfizer-BioNTech
2	2021-05-11	Pfizer-BioNTech
3	2021-12-10	Pfizer-BioNTech	Flu
4	2022-10-26	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 8 — day 14, dose 1

2021-04-28

Symptoms: Hives that began 4/26 for with no known cause.

Release 8 — day 21, dose 1

2021-05-04

Symptoms: Hives

Release 8 — days 1–6 daily, dose 2

2021-05-12

Systemic reaction (other): Dizziness

2021-05-13

Systemic reaction (other): Swollen lymph nodes around collar bone on side I received shot

2021-05-14

Systemic reaction (other): Swollen nodes around collar bone on side of injection.

2021-05-15

Systemic reaction (other): Swollen lymph node on side of injection

2021-05-16

Systemic reaction (other): Swelling of lymph nodes under clavicle same side as vaccination

2021-05-17

Systemic reaction (other): Swollen lymph node on side of injection, under clavicle

Release 8 — day 7, dose 2

2021-05-18

Systemic reaction (other): Swollen lymph node under clavicle on injection side

Release 10 — 6 months, dose 2

2021-11-09

Symptoms: Acne/hormonal fluctuations

Release 12 — days 1–6 daily, dose 4

2022-11-01

Systemic reaction (other): Canker sore

Release 12 — day 7, dose 4

2022-11-02

Systemic reaction (other): Canker sore

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
SD	Acne	·	·	✓
SD	Hormone level abnormal	·	·	✓
SD	Urticaria	✓	✓	✓
SRO	Aphthous ulcer	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓

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