4WE-30514-10160

3 vaccinations 9 coded responses 14 check-ins 9 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 890 / NV
Registered: 2021-02-20

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

2021-01-22
Dose 1 — Pfizer-BioNTech
2021-02-12
Dose 2 — Pfizer-BioNTech
2021-02-20
Registered in v-safe
2021-02-20
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-26
Survey response — day 14, dose 2
MedDRA: Infection — Feeling: Fair

Free text: Severe infections

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — day 21, dose 2
MedDRA: Dyspnoea, Hospitalisation, Sepsis — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Sepsis, difficulty breathing, etc. hospitalized 5 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-26
Survey response — day 42, dose 2
MedDRA: Bacterial sepsis, Bacterial test positive, Hospitalisation, Injection, Pain — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Septic bacteria in blood...hospital. This morning neck injection. Still very painful but beginning to relieve pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-14
Survey response — 6 months, dose 2
MedDRA: Hospitalisation, Pneumonia, Surgery — 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, Emergency room or emergency department visit, Hospitalization

Free text: Hospitalized with pneumonia Two surgeries

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-14
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-21
Call 1 — Left Voicemail
2021-09-20
Dose 3 — Pfizer-BioNTech
2021-10-04
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-10-13
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-10-20
Survey response — day 28, dose 3
MedDRA: Pulmonary embolism — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Pulmonary embolis

MedDRA releases: 2024-11 · check-in free text available
2021-10-25
Survey response — day 35, dose 3
MedDRA: Intensive care, Pulmonary embolism, Thrombosis, Vascular operation — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Huge PE removed. 4 days ICU. Remaining clots right leg. Screen placed. Hopefully dissolve in six months or so

MedDRA releases: 2024-11 · check-in free text available
2021-10-25
Report sent to call center — day 35, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-10-26
Call 1 — Left Voicemail
2021-10-26
Call successful
Participant prefers to complete VAERS report online
2021-11-01
Survey response — day 42, dose 3
MedDRA: Intensive care, Pulmonary embolism, Thrombosis — Feeling: Good · Be unable to work or attend school, 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: Symptoms: Pulmonary embolism and multiple clots in right leg · Healthcare visit (other): Radiology then ICU

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Report sent to call center — day 42, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · 1 call case(s)
2021-12-20
Survey response — 3 months, dose 3
MedDRA: Hypotension — Feeling: Good

Free text: Very low blood pressure

MedDRA releases: 2024-11 · check-in free text available
2022-03-23
Survey response — 6 months, dose 3
MedDRA: Pneumonia — Feeling: Good · Be unable to do your normal daily activities

Free text: Oneumonia

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Pfizer-BioNTech
2	2021-02-12	Pfizer-BioNTech
3	2021-09-20	Pfizer-BioNTech	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 4 — day 14, dose 2

2021-02-26

Symptoms: Severe infections

Release 5 — day 21, dose 2

2021-03-05

Symptoms: Sepsis, difficulty breathing, etc. hospitalized 5 days

Release 6 — day 42, dose 2

2021-03-26

Symptoms: Septic bacteria in blood...hospital. This morning neck injection. Still very painful but beginning to relieve pain.

Release 9 — 6 months, dose 2

2021-08-14

Symptoms: Hospitalized with pneumonia Two surgeries

Release 10 — day 28, dose 3

2021-10-20

Symptoms: Pulmonary embolis

Release 10 — day 35, dose 3

2021-10-25

Symptoms: Huge PE removed. 4 days ICU. Remaining clots right leg. Screen placed. Hopefully dissolve in six months or so

Release 10 — day 42, dose 3

2021-11-01

Symptoms: Pulmonary embolism and multiple clots in right leg

Healthcare visit (other): Radiology then ICU

Release 10 — 3 months, dose 3

2021-12-20

Symptoms: Very low blood pressure

Release 11 — 6 months, dose 3

2022-03-23

Symptoms: Oneumonia

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	Intensive care	·	·	✓
SD	Bacterial sepsis	✓	✓	✓
SD	Bacterial test positive	✓	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Hypotension	·	·	✓
SD	Infection	✓	✓	✓
SD	Injection	✓	·	✓
SD	Intensive care	·	·	✓
SD	Pain	✓	·	✓
SD	Pneumonia	✓	·	✓
SD	Pulmonary embolism	·	·	✓
SD	Sepsis	✓	✓	✓
SD	Surgery	✓	·	✓
SD	Thrombosis	·	·	✓
SD	Vascular operation	·	·	✓

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