4UT-70051-36878

2 vaccinations 5 coded responses 22 check-ins 5 free-text entries 3 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 460 / IN
Registered: 2021-03-09

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

Registered dependents

XTB-16730-05802 Child or adolescent in my care · Male · 2022-02-26

Timeline

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

2021-03-09
Registered in v-safe
2021-03-09
Dose 1 — Pfizer-BioNTech
2021-03-09
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-10
Survey response — days 1–6 daily, dose 1
MedDRA: Hypoaesthesia oral, Immunisation reaction, Lip swelling, Self-medication, Swollen tongue — Feeling: Poor · Site: Pain · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I had the vaccine at 3pm on 3/9. I woke up on 3/10 at 3am with swollen and numb lips. I was given an IV at the emergency room with steroids and antihistamines. Today the numbness and swelling of my lips and area around my lips continues. My tongue is also a little swollen. I am taking Benadryl. The ER doctor diagnosed me as having an allergic reaction to the Pfizer vaccine and and advised me not to take the 2nd vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Report sent to call center — days 1–6 daily, dose 1
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)
2021-03-11
Survey response — days 1–6 daily, dose 1
MedDRA: Lip swelling, Mouth swelling — Feeling: Fair · Be unable to work, 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: Swollen lips and mouth area around lips

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Report sent to call center — days 1–6 daily, dose 1
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)
2021-03-12
Survey response — days 1–6 daily, dose 1
MedDRA: Hypoaesthesia oral, Lip swelling, Self-medication, Swelling — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Swelling and numbness of lips and around mouth area is now minimal. I have been taking Benadryl.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness, Diarrhea

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-18
Health check-in — day 7, dose 1
Feeling: Good · Fever · Fatigue or tiredness

Adult check-in
2021-03-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-06
Survey response — day 28, dose 1
MedDRA: Headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Intermittent Headaches, which I typically dont get.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Health check-in — day 35, dose 1
Feeling: Good

Adult check-in
2021-04-24
Health check-in — day 42, dose 1
Feeling: Good

Adult check-in
2021-06-08
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-09-09
Survey response — 6 months, dose 1
MedDRA: Mass, Nephrolithiasis, Office visit, Pre-existing disease, Renal impairment, Renal stone removal, Surgery — 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

Free text: Symptoms: I was born w double ureter.Surgery to remove a stone blocking left ureters/kidney &a mass around the stone. Left Kidney still not working 1 month after surgery. 2 months post surgery the kidney has started to drain again (not fully functioning yet). · Healthcare visit (other): Outpatient surgery and in-person appointments with dr. I have had 2 cat scans, X-rays, an infrasound and blood work since June 2021.

MedDRA releases: 2024-11 · check-in free text available
2021-09-09
Report sent to call center — 6 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

1 call case(s)
2021-09-10
Call 2 — Left Voicemail
2021-09-24
Call 3 — Could Not Reach Participant
2022-02-26
Call 1 — Left Voicemail
2022-03-01
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-03-02
Dose 2 — Pfizer-BioNTech
2022-03-02
Health check-in — day 0, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-03-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2022-03-30
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2022-09-02
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2023-03-02
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-09	Pfizer-BioNTech
2	2022-03-02	Pfizer-BioNTech	No

Call center

3 call center cases

3 successful

VAERS report filed, before or during a call: 3

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-10

Systemic reaction (other): I had the vaccine at 3pm on 3/9. I woke up on 3/10 at 3am with swollen and numb lips. I was given an IV at the emergency room with steroids and antihistamines. Today the numbness and swelling of my lips and area around my lips continues. My tongue is also a little swollen. I am taking Benadryl. The ER doctor diagnosed me as having an allergic reaction to the Pfizer vaccine and and advised me not to take the 2nd vaccine.

2021-03-11

Systemic reaction (other): Swollen lips and mouth area around lips

2021-03-12

Systemic reaction (other): Swelling and numbness of lips and around mouth area is now minimal. I have been taking Benadryl.

Release 7 — day 28, dose 1

2021-04-06

Symptoms: Intermittent Headaches, which I typically dont get.

Release 9 — 6 months, dose 1

2021-09-09

Symptoms: I was born w double ureter.Surgery to remove a stone blocking left ureters/kidney &a mass around the stone. Left Kidney still not working 1 month after surgery. 2 months post surgery the kidney has started to drain again (not fully functioning yet). cut off by CDC

Healthcare visit (other): Outpatient surgery and in-person appointments with dr. I have had 2 cat scans, X-rays, an infrasound and blood work since June 2021.

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	Office visit	·	·	✓
HCVO	Surgery	·	·	✓
SD	Headache	✓	✓	✓
SD	Mass	·	·	✓
SD	Nephrolithiasis	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Renal impairment	·	·	✓
SD	Renal stone removal	·	·	✓
SRO	Hypoaesthesia oral	✓	✓	✓
SRO	Immunisation reaction	✓	✓	✓
SRO	Lip swelling	✓	✓	✓
SRO	Mouth swelling	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Swelling	·	·	✓
SRO	Swollen tongue	✓	✓	✓

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