4WQ-20014-22106

4 vaccinations 10 coded responses 16 check-ins 10 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 284 / NC
Registered: 2021-01-17

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

2021-01-10
Dose 1 — Pfizer-BioNTech
2021-01-17
Registered in v-safe
2021-01-17
Survey response — day 7, dose 1
MedDRA: Back pain, Chest pain, Dyspnoea, Hypertension — Feeling: Fair · Chills, Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site · 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: Yes, shortness of breath and chest and back pain, HBP

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Report sent to call center — day 7, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-31
Dose 2 — Pfizer-BioNTech
2021-02-07
Survey response — day 7, dose 2
MedDRA: Palpitations — Feeling: Fair · Muscle or body aches

Free text: Heart racing sporadically

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Survey response — day 14, dose 2
MedDRA: Atrioventricular block, Chest pain, Dyspnoea, Office visit — Feeling: Fair · 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: Shortness of breath and chest pain. Recently, diagnosed with blockage in heart. Heart Cath scheduled for 2/25/21. First symptom received 1/16/21, no prior shortness of breath or chest pain. No need for Cardiologist prior. · Healthcare visit (other): Plus cardiologist in in-office visit and Stress Test

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-21
Survey response — day 21, dose 2
MedDRA: Dizziness, Dyspnoea — Feeling: Poor · Be unable to do your normal daily activities

Free text: Shortness of breath and dizziness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-07
Survey response — day 35, dose 2
MedDRA: Burning sensation, Catheterisation cardiac abnormal, Headache, Hospitalisation, Pain in extremity, Pre-existing disease, Skin discolouration, Stent placement — 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, Hospitalization

Free text: Symptoms: Recently had a heart Cath and stent implanted. Complications of s pseudo aneurysm and painful, burning and 4X8 gray/bluish discoloration on inner thigh that within 3 inches of knee. Painful burning now behind knee. Steady headache, otherwise good · Healthcare visit (other): Follow up with second ultrasound after hospital discharge

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-14
Survey response — day 42, dose 2
MedDRA: Burning sensation, Emergency care, Thrombosis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Burning in the thigh and leg. May be as a result of heart Cath on 2/25 where migration of blood leaked Dow leg from catheter, per cardiologist. No previous varicose vein issues, now have a blood clot in lower leg and pseudoaneuysm. · Healthcare visit (other): Cardiologist appointment on 3:9 and scheduled vascular surgeon appointment on 3/17. No previous heart issues prior to 1/16/21 ER visit resulting in referral to Cardiologist. First Covid vaccine was 1/10/21. Know vaccine not total reason for problem, since 90% obstruction found recently and stent implemented on 2/25/21.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-17
Call 1 — Left Voicemail
2021-05-02
Survey response — 3 months, dose 2
MedDRA: Cardiac stress test abnormal, Catheterisation cardiac, Catheterisation cardiac abnormal, Coronary arterial stent insertion, Coronary artery occlusion, Peripheral artery thrombosis, Stent placement, Thrombosis, Vascular pseudoaneurysm — 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, Hospitalization

Free text: Stress test on 2/9 revealed need for heart catheter. On 2/25, stent was implanted due to 90%blockage. Nic in femoral artery during cath caused pseudo aneurysm and blood clot. Currently, on Plavix & Eloquis. FU with Vascular Surgeon &Cardiologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-31
Call 1 — Left Voicemail
2021-08-03
Call 3 — Left Voicemail
2021-09-21
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2021-09-30
Survey response — day 7, dose 3
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-10-05
Survey response — day 14, dose 3
MedDRA: Anxiety, Heart rate increased — Feeling: Good

Free text: Occasionally, sporadic short episodes of a racing heart beat. Think it might be as I suspect it felt like anxiety, however, don't recall experiencing it previously.

MedDRA releases: 2024-11 · check-in free text available
2021-10-19
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-10-26
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-02
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-22
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-30
Dose 4 — Moderna
2022-07-30
Survey response — 3 months, dose 4
MedDRA: Breast enlargement, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Enlarging left breast. No pain, no nodes detected. · Healthcare visit (other): Diagnostic mammogram ordered.

MedDRA releases: 2024-11 · check-in free text available
2022-07-30
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-08-01
Call 2 — Left Voicemail
2022-08-01
Call 1 — Left Voicemail
2022-08-01
Call 1 — Left Voicemail
2022-08-01
Call 1 — Left Voicemail
2022-08-01
Call 2 — Left Voicemail
2022-08-01
Call 1 — Requested Callback
2022-08-01
Call successful
Not applicable - Accidental Reporting
2022-08-01
Call successful
Not applicable - Accidental Reporting
2022-08-01
Call successful
Not applicable - Accidental Reporting
2022-08-01
Call successful
Not applicable - Accidental Reporting
2022-08-01
Call successful
Not applicable - Accidental Reporting
2022-08-02
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-10	Pfizer-BioNTech
2	2021-01-31	Pfizer-BioNTech
3	2021-09-21	Pfizer-BioNTech	Flu
4	2022-04-30	Moderna	No

Call center

6 call center cases

6 successful

4 waits over 3 months for a first call

See the call center timeline

Free text

Release 2 — day 7, dose 1

2021-01-17

Systemic reaction (other): Yes, shortness of breath and chest and back pain, HBP

Release 3 — day 7, dose 2

2021-02-07

Systemic reaction (other): Heart racing sporadically

Release 4 — day 14, dose 2

2021-02-14

Symptoms: Shortness of breath and chest pain. Recently, diagnosed with blockage in heart. Heart Cath scheduled for 2/25/21. First symptom received 1/16/21, no prior shortness of breath or chest pain. No need for Cardiologist prior.

Healthcare visit (other): Plus cardiologist in in-office visit and Stress Test

Release 4 — day 21, dose 2

2021-02-21

Symptoms: Shortness of breath and dizziness.

Release 5 — day 35, dose 2

2021-03-07

Symptoms: Recently had a heart Cath and stent implanted. Complications of s pseudo aneurysm and painful, burning and 4X8 gray/bluish discoloration on inner thigh that within 3 inches of knee. Painful burning now behind knee. Steady headache, otherwise good cut off by CDC

Healthcare visit (other): Follow up with second ultrasound after hospital discharge

Release 5 — day 42, dose 2

2021-03-14

Symptoms: Burning in the thigh and leg. May be as a result of heart Cath on 2/25 where migration of blood leaked Dow leg from catheter, per cardiologist. No previous varicose vein issues, now have a blood clot in lower leg and pseudoaneuysm.

Healthcare visit (other): Cardiologist appointment on 3:9 and scheduled vascular surgeon appointment on 3/17. No previous heart issues prior to 1/16/21 ER visit resulting in referral to Cardiologist. First Covid vaccine was 1/10/21. Know vaccine not total reason for problem, since 90% obstruction found recently and stent implemented on 2/25/21.

Release 8 — 3 months, dose 2

2021-05-02

Symptoms: Stress test on 2/9 revealed need for heart catheter. On 2/25, stent was implanted due to 90%blockage. Nic in femoral artery during cath caused pseudo aneurysm and blood clot. Currently, on Plavix & Eloquis. FU with Vascular Surgeon &Cardiologist cut off by CDC

Release 9 — day 7, dose 3

2021-09-30

Systemic reaction (other): No

Release 10 — day 14, dose 3

2021-10-05

Symptoms: Occasionally, sporadic short episodes of a racing heart beat. Think it might be as I suspect it felt like anxiety, however, don't recall experiencing it previously.

Release 12 — 3 months, dose 4

2022-07-30

Symptoms: Enlarging left breast. No pain, no nodes detected.

Healthcare visit (other): Diagnostic mammogram ordered.

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	Emergency care	✓	✓	✓
HCVO	Hospitalisation	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Unevaluable event	·	·	✓
SD	Anxiety	·	·	✓
SD	Atrioventricular block	✓	✓	✓
SD	Breast enlargement	·	·	✓
SD	Burning sensation	✓	✓	✓
SD	Cardiac stress test abnormal	✓	·	✓
SD	Catheterisation cardiac	○	✓	○
SD	Catheterisation cardiac abnormal	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Coronary arterial stent insertion	✓	·	✓
SD	Coronary artery occlusion	✓	·	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Heart rate increased	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Peripheral artery thrombosis	✓	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Skin discolouration	✓	✓	✓
SD	Stent placement	✓	✓	✓
SD	Thrombosis	✓	✓	✓
SD	Vascular pseudoaneurysm	✓	·	✓
SRO	Back pain	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Hypertension	✓	✓	✓
SRO	No adverse event	·	·	✓
SRO	Palpitations	✓	✓	✓

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