4UV-15069-20721

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

Sex: Male
Age at first dose: 61-65
ZIP prefix: 183 / PA
Registered: 2021-03-15

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

2021-03-15
Registered in v-safe
2021-03-15
Dose 1 — Pfizer-BioNTech
2021-03-15
Survey response — day 0, dose 1
MedDRA: Dizziness — Feeling: Fair · Muscle or body aches

Free text: A bit lightheaded

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Survey response — days 1–6 daily, dose 1
MedDRA: Dysuria, Flank pain — Feeling: Fair · Site: Pain, Redness · Muscle or body aches, Abdominal pain

Free text: Pain on right side (may be muscle ache/pain), can feel it during urinating but alone sometimes as well

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — days 1–6 daily, dose 1
MedDRA: Myalgia, Pain in extremity, Pollakiuria — Feeling: Good · Fever · Muscle or body aches

Free text: Less aches and very minor aches in left forearm (arm shot was given) and upper left chest muscle aches ). I forgot to mention at night of 3/15 injection, I experienced frequent urinating (every 15 minutes for about two hours). But that went away and hasnt happened since.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Myalgia — Feeling: Good · Muscle or body aches

Free text: Some muscle aches, but I dont think theyre related to the vaccine since I had them before the shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Muscle or body aches

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — day 7, dose 1
Feeling: Fair · Fever · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-05
Dose 2 — Pfizer-BioNTech
2021-04-05
Health check-in — day 0, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Muscle or body aches

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches

Adult check-in
2021-04-12
Health check-in — day 7, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-04-19
Survey response — day 14, dose 2
MedDRA: Condition aggravated, Diabetic neuropathy, Pre-existing disease — Feeling: Good

Free text: My diabetic peripheral neuropathy seemed to get worse after getting both shots. It seems to be a bit better today, but I also have taken a double dose of gabapentin at night that was prescribed to me.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Survey response — day 21, dose 2
MedDRA: Arthralgia, Chest discomfort, Constipation, Dizziness, Fatigue, Myalgia, Neuropathy peripheral — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Fatigue, muscle & joint aches, lightheaded, chest discomfort, peripheral neuropathy, constipation. I went to Doctor today for lab work. We dont think its related to COVID or the vaccine shots at this time.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-03
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-10
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-17
Survey response — day 42, dose 2
MedDRA: Dizziness, Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue and lightheaded

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-05
Survey response — 3 months, dose 2
MedDRA: Dizziness, Heart rate decreased — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Lightheaded, dizzy, very low heart rates

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-05
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-08
Call 1 — Left Voicemail
2021-10-04
Survey response — 6 months, dose 2
MedDRA: Balance disorder, Brain fog, Dizziness, Fatigue, Gait disturbance, Heart rate decreased, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Low heart rate. Sometimes brain fog, dizziness & lightheaded, fatigue and slight loss of balance while walking. · Healthcare visit (other): Primary doctor office visit.

MedDRA releases: 2024-11 · check-in free text available
2021-10-04
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-07
Call successful
Participant prefers to complete VAERS report online
2021-10-07
Call successful
Participant prefers to complete VAERS report online
2021-12-14
Dose 3 — Moderna
2022-04-05
Survey response — 12 months, dose 2
MedDRA: Abdominal pain upper, Back pain, Flank pain, Neuropathy peripheral, Office visit — Feeling: Good · 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: Moderate back, side & stomach pain (CT Scan was negative), peripheral neuropathy in left thigh moderate to severe, but seems to be dissipating now · Healthcare visit (other): Doctor office visit & hospital out patient CR Scan

MedDRA releases: 2024-11 · check-in free text available
2022-04-05
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-06
Call 1 — Left Voicemail
2022-06-14
Survey response — 6 months, dose 3
MedDRA: Neuropathy peripheral, Tendonitis — Feeling: Good

Free text: Neuropathy in left thigh that only now is starting to dissipate Tendinitis in left elbow

MedDRA releases: 2024-11 · check-in free text available
2022-12-14
Survey response — 12 months, dose 3
MedDRA: Arthralgia, Chest pain, Musculoskeletal chest pain — Feeling: Good

Free text: Aches and pains in chest, shoulders and rib area. Moderate but not severe pain. Lasted about 2 weeks or so.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-15	Pfizer-BioNTech
2	2021-04-05	Pfizer-BioNTech
3	2021-12-14	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 5 — day 0, dose 1

2021-03-15

Systemic reaction (other): A bit lightheaded

Release 5 — days 1–6 daily, dose 1

2021-03-16

Systemic reaction (other): Pain on right side (may be muscle ache/pain), can feel it during urinating but alone sometimes as well

2021-03-17

Systemic reaction (other): Less aches and very minor aches in left forearm (arm shot was given) and upper left chest muscle aches ). I forgot to mention at night of 3/15 injection, I experienced frequent urinating (every 15 minutes for about two hours). But that went away and hasnt happened since.

2021-03-18

Systemic reaction (other): Some muscle aches, but I dont think theyre related to the vaccine since I had them before the shot.

Release 7 — day 14, dose 2

2021-04-19

Symptoms: My diabetic peripheral neuropathy seemed to get worse after getting both shots. It seems to be a bit better today, but I also have taken a double dose of gabapentin at night that was prescribed to me.

Release 7 — day 21, dose 2

2021-04-26

Symptoms: Fatigue, muscle & joint aches, lightheaded, chest discomfort, peripheral neuropathy, constipation. I went to Doctor today for lab work. We dont think its related to COVID or the vaccine shots at this time.

Release 8 — day 42, dose 2

2021-05-17

Symptoms: Fatigue and lightheaded

Release 9 — 3 months, dose 2

2021-07-05

Symptoms: Lightheaded, dizzy, very low heart rates

Release 9 — 6 months, dose 2

2021-10-04

Symptoms: Low heart rate. Sometimes brain fog, dizziness & lightheaded, fatigue and slight loss of balance while walking.

Healthcare visit (other): Primary doctor office visit.

Release 11 — 12 months, dose 2

2022-04-05

Symptoms: Moderate back, side & stomach pain (CT Scan was negative), peripheral neuropathy in left thigh moderate to severe, but seems to be dissipating now

Healthcare visit (other): Doctor office visit & hospital out patient CR Scan

Release 12 — 6 months, dose 3

2022-06-14

Symptoms: Neuropathy in left thigh that only now is starting to dissipate Tendinitis in left elbow

Release 12 — 12 months, dose 3

2022-12-14

Symptoms: Aches and pains in chest, shoulders and rib area. Moderate but not severe pain. Lasted about 2 weeks or so.

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	·	·	✓
SD	Abdominal pain upper	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	·	·	✓
SD	Balance disorder	·	·	✓
SD	Brain fog	·	·	✓
SD	Chest discomfort	✓	✓	✓
SD	Chest pain	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Constipation	✓	✓	✓
SD	Diabetic neuropathy	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Flank pain	·	·	✓
SD	Gait disturbance	·	·	✓
SD	Heart rate decreased	✓	✓	✓
SD	Musculoskeletal chest pain	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Neuropathy peripheral	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Tendonitis	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Dysuria	✓	✓	✓
SRO	Flank pain	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pollakiuria	✓	✓	✓

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