4XA-21762-11980

5 vaccinations 18 coded responses 40 check-ins 17 free-text entries 0 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 949 / CA
Registered: 2021-04-10

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

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-04-10
Registered in v-safe
2021-04-10
Dose 1 — Pfizer-BioNTech
2021-04-10
Survey response — day 0, dose 1
MedDRA: Pruritus — Feeling: Good

Free text: Itching everywhere, not just arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-04-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-04-19
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-01
Dose 2 — Pfizer-BioNTech
2021-05-01
Health check-in — day 0, dose 2
Feeling: Fair · Headache, Diarrhea

Adult check-in
2021-05-02
Survey response — days 1–6 daily, dose 2
MedDRA: Disorientation, Tinnitus — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Ringing ears and disorientation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Survey response — days 1–6 daily, dose 2
MedDRA: Tinnitus — Feeling: Poor · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Ringing ears

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Survey response — days 1–6 daily, dose 2
MedDRA: Heavy menstrual bleeding, Tinnitus — Feeling: Poor · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Ringing ears, untimely, heavy menstruation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Survey response — days 1–6 daily, dose 2
MedDRA: Heavy menstrual bleeding, Menstruation irregular, Tinnitus — Feeling: Fair · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Heavy irregular menstruation, ringing ears

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Survey response — days 1–6 daily, dose 2
MedDRA: Tinnitus — Feeling: Fair · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Ringing ears

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-05-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-31
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-05
Survey response — day 35, dose 2
MedDRA: Heart rate irregular — Feeling: Fair

Free text: Irregular pulse

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-12
Survey response — day 42, dose 2
MedDRA: Headache, Heart rate irregular, Myalgia, Vision blurred — Feeling: Fair

Free text: Blurry eyes, irregular heartbeat, headache, muscle pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-31
Survey response — 3 months, dose 2
MedDRA: Asthenia, Dizziness, Palpitations — Feeling: Poor · Be unable to do your normal daily activities

Free text: Dizziness, heart palpitations, weakness

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-30
Survey response — 6 months, dose 2
MedDRA: Asthenia, Fatigue, Pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Weakness, fatigued, sudden pain here and there in my body.

MedDRA releases: 2024-11 · check-in free text available
2021-11-20
Dose 3 — Moderna
2021-11-23
Survey response — days 1–6 daily, dose 3
MedDRA: Palpitations — Feeling: Fair · Site: Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Palpitations

MedDRA releases: 2024-11 · check-in free text available
2021-11-24
Survey response — days 1–6 daily, dose 3
MedDRA: Palpitations — Feeling: Fair · Site: Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Palpitations

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-11-26
Survey response — days 1–6 daily, dose 3
MedDRA: Palpitations — Feeling: Fair · Site: Swelling · Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Free text: Palpitations

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Survey response — day 7, dose 3
MedDRA: Palpitations — Feeling: Fair · Site: Pain · Fatigue or tiredness, Nausea

Free text: Palpitations

MedDRA releases: 2024-11 · check-in free text available
2021-12-04
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-12-11
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-12-18
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-25
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-03
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-02-19
Survey response — 3 months, dose 3
MedDRA: Asthenia — Feeling: Fair

Free text: Weakness

MedDRA releases: 2024-11 · check-in free text available
2022-05-24
Dose 4 — Moderna
2022-11-19
Dose 5 — Moderna
2022-11-20
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in
2022-11-22
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2022-11-24
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-11-28
Health check-in — day 7, dose 5
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2022-12-03
Survey response — day 14, dose 5
MedDRA: Cough, Headache, Throat irritation — Feeling: Fair

Free text: Coughing, headache, and itchy throat

MedDRA releases: 2024-11 · check-in free text available
2022-12-12
Survey response — day 21, dose 5
MedDRA: Dyspnoea — Feeling: Fair

Free text: Shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2023-02-20
Survey response — 3 months, dose 5
MedDRA: Adverse reaction — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-10	Pfizer-BioNTech
2	2021-05-01	Pfizer-BioNTech
3	2021-11-20	Moderna	No
4	2022-05-24	Moderna	No
5	2022-11-19	Moderna	No

Free text

Release 7 — day 0, dose 1

2021-04-10

Systemic reaction (other): Itching everywhere, not just arm

Release 8 — days 1–6 daily, dose 2

2021-05-02

Systemic reaction (other): Ringing ears and disorientation

2021-05-03

Systemic reaction (other): Ringing ears

2021-05-04

Systemic reaction (other): Ringing ears, untimely, heavy menstruation

2021-05-05

Systemic reaction (other): Heavy irregular menstruation, ringing ears

2021-05-06

Systemic reaction (other): Ringing ears

Release 8 — day 35, dose 2

2021-06-05

Symptoms: Irregular pulse

Release 9 — day 42, dose 2

2021-06-12

Symptoms: Blurry eyes, irregular heartbeat, headache, muscle pain.

Release 9 — 3 months, dose 2

2021-07-31

Symptoms: Dizziness, heart palpitations, weakness

Release 10 — 6 months, dose 2

2021-10-30

Symptoms: Weakness, fatigued, sudden pain here and there in my body.

Release 10 — days 1–6 daily, dose 3

2021-11-23

Systemic reaction (other): Palpitations

2021-11-24

Systemic reaction (other): Palpitations

2021-11-26

Systemic reaction (other): Palpitations

Release 10 — day 7, dose 3

2021-11-27

Systemic reaction (other): Palpitations

Release 11 — 3 months, dose 3

2022-02-19

Symptoms: Weakness

Release 12 — day 14, dose 5

2022-12-03

Symptoms: Coughing, headache, and itchy throat

Release 12 — day 21, dose 5

2022-12-12

Symptoms: Shortness of breath

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	Adverse reaction	·	·	✓
SD	Asthenia	✓	·	✓
SD	Cough	·	·	✓
SD	Dizziness	✓	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	✓	✓
SD	Heart rate irregular	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Pain	·	·	✓
SD	Palpitations	✓	·	✓
SD	Throat irritation	·	·	✓
SD	Vision blurred	✓	✓	✓
SRO	Disorientation	✓	✓	✓
SRO	Heavy menstrual bleeding	✓	✓	✓
SRO	Menstruation irregular	✓	✓	✓
SRO	Palpitations	·	·	✓
SRO	Pruritus	✓	✓	✓
SRO	Tinnitus	✓	✓	✓

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