53W-15782-18592

1 vaccination 12 coded responses 14 check-ins 12 free-text entries 4 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 130 / NY
Registered: 2021-09-13

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

2021-09-13
Registered in v-safe
2021-09-13
Dose 1 — Pfizer-BioNTech
2021-09-13
Survey response — day 0, dose 1
MedDRA: Abdominal discomfort, Throat irritation, Urticaria — Feeling: Poor · Site: Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Itchy throat , GI distress , hives

MedDRA releases: 2024-11 · check-in free text available
2021-09-13
Report sent to call center — day 0, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-14
Survey response — days 1–6 daily, dose 1
MedDRA: Nasal congestion, Urticaria — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Hives , nasal congestion

MedDRA releases: 2024-11 · check-in free text available
2021-09-15
Survey response — days 1–6 daily, dose 1
MedDRA: Tachycardia — Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Tachycardia

MedDRA releases: 2024-11 · check-in free text available
2021-09-16
Survey response — days 1–6 daily, dose 1
MedDRA: Tachycardia — Feeling: Poor · Site: Pain, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Tachycardia

MedDRA releases: 2024-11 · check-in free text available
2021-09-16
Call successful
Completed over the phone
2021-09-17
Survey response — days 1–6 daily, dose 1
MedDRA: Tachycardia — Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Joint pains, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work or attend school

Free text: Tachycardia

MedDRA releases: 2024-11 · check-in free text available
2021-09-18
Survey response — days 1–6 daily, dose 1
MedDRA: Facial pain, Insomnia, Nightmare, Pain in jaw, Tachycardia — Feeling: Poor · Site: Swelling · Headache, Joint pains, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Tachycardia , jaw pain, facial pain, insomnia, nightmares

MedDRA releases: 2024-11 · check-in free text available
2021-09-19
Survey response — days 1–6 daily, dose 1
MedDRA: Bone pain, Pain in extremity, Pain in jaw, Tachycardia — Feeling: Poor · Site: Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Tachycardia, jaw pain, nasal bone pain, leg pain

MedDRA releases: 2024-11 · check-in free text available
2021-09-20
Survey response — day 7, dose 1
MedDRA: Facial pain, Nightmare, Pain in extremity, Tachycardia — Feeling: Fair · Site: Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Tachycardia , left leg pain, facial pain, nightmares

MedDRA releases: 2024-11 · check-in free text available
2021-09-27
Survey response — day 14, dose 1
MedDRA: Arthralgia, Facial pain, Flushing, Headache, Pain in jaw — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Daily headaches , daily jaw & facial pain , upper & lower extremity joint pain, flushing of the face

MedDRA releases: 2024-11 · check-in free text available
2021-10-04
Survey response — day 21, dose 1
MedDRA: Fatigue, Headache, Nausea, Photosensitivity reaction, Tachycardia, Vomiting — Feeling: Poor · 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: Intractable Headache , nausea / vomiting , photosensitivity , fatigue , tachycardia

MedDRA releases: 2024-11 · check-in free text available
2021-10-04
Report sent to call center — day 21, 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

Emergency room or emergency department visit · 1 call case(s)
2021-10-05
Call 1 — Left Voicemail
2021-10-12
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-10-21
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-12-13
Survey response — 3 months, dose 1
MedDRA: Hallucination — Feeling: Fair · 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: Hallucinations

MedDRA releases: 2024-11 · check-in free text available
2021-12-13
Report sent to call center — 3 months, dose 1
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)
2021-12-14
Call 1 — Left Voicemail
2022-03-18
Survey response — 6 months, dose 1
MedDRA: Hallucination, Headache, Rash — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Rashes , hallucinations , headaches

MedDRA releases: 2024-11 · check-in free text available
2022-03-18
Report sent to call center — 6 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-21
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-09-13	Pfizer-BioNTech	No

Call center

4 call center cases

4 successful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 9 — day 0, dose 1

2021-09-13

Systemic reaction (other): Itchy throat , GI distress , hives

Release 9 — days 1–6 daily, dose 1

2021-09-14

Systemic reaction (other): Hives , nasal congestion

2021-09-15

Systemic reaction (other): Tachycardia

2021-09-16

Systemic reaction (other): Tachycardia

2021-09-17

Systemic reaction (other): Tachycardia

2021-09-18

Systemic reaction (other): Tachycardia , jaw pain, facial pain, insomnia, nightmares

2021-09-19

Systemic reaction (other): Tachycardia, jaw pain, nasal bone pain, leg pain

Release 9 — day 7, dose 1

2021-09-20

Systemic reaction (other): Tachycardia , left leg pain, facial pain, nightmares

Release 9 — day 14, dose 1

2021-09-27

Symptoms: Daily headaches , daily jaw & facial pain , upper & lower extremity joint pain, flushing of the face

Release 10 — day 21, dose 1

2021-10-04

Symptoms: Intractable Headache , nausea / vomiting , photosensitivity , fatigue , tachycardia

Release 10 — 3 months, dose 1

2021-12-13

Symptoms: Hallucinations

Release 11 — 6 months, dose 1

2022-03-18

Symptoms: Rashes , hallucinations , headaches

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	Arthralgia	·	·	✓
SD	Facial pain	·	·	✓
SD	Fatigue	·	·	✓
SD	Flushing	·	·	✓
SD	Hallucination	·	·	✓
SD	Headache	·	·	✓
SD	Nausea	·	·	✓
SD	Pain in jaw	·	·	✓
SD	Photosensitivity reaction	·	·	✓
SD	Rash	·	·	✓
SD	Tachycardia	·	·	✓
SD	Vomiting	·	·	✓
SRO	Abdominal discomfort	·	·	✓
SRO	Bone pain	·	·	✓
SRO	Facial pain	·	·	✓
SRO	Insomnia	·	·	✓
SRO	Nasal congestion	·	·	✓
SRO	Nightmare	·	·	✓
SRO	Pain in extremity	·	·	✓
SRO	Pain in jaw	·	·	✓
SRO	Tachycardia	·	·	✓
SRO	Throat irritation	·	·	✓
SRO	Urticaria	·	·	✓

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