58Z-29935-78814

4 vaccinations 9 coded responses 28 check-ins 9 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 030 / NH
Registered: 2021-04-29

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

Registered dependents

JKD-25334-59580 Child or adolescent in my care · Female · 2022-07-13

Timeline

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

2021-04-07
Dose 1 — Pfizer-BioNTech
2021-04-28
Dose 2 — Pfizer-BioNTech
2021-04-29
Registered in v-safe
2021-04-29
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-01
Survey response — days 1–6 daily, dose 2
MedDRA: Eye pain, Pain — Feeling: Good · Joint pains · Be unable to do your normal daily activities

Free text: Eyes have mild pain when I move them side to side or up and down quickly or hold them in a position other than straight forward

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Survey response — days 1–6 daily, dose 2
MedDRA: Eye movement disorder, Loss of personal independence in daily activities, Ocular discomfort — Feeling: Good · Be unable to do your normal daily activities

Free text: Eyes are still bothering me whenever I move them within the socket (e.g. when I look left or right, up or down). Prevents me from performing some activities

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: Eye pain — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Eye pain

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: Eye pain, Ocular discomfort — Feeling: Good

Free text: Still having eye discomfort/pain but its better today than yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Survey response — day 7, dose 2
MedDRA: Ocular discomfort — Feeling: Good

Free text: Eye discomfort still persists but is finally getting better!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-19
Survey response — day 21, dose 2
MedDRA: Back pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Back (lumbar) pain, primarily when sitting, started about the same day as last check-in but I didnt think to note it then. Its a feeling Ive never had before and I cant attribute it to anything other than, likely, the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-26
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-06-02
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-06-09
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-28
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-10-27
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-27
Dose 3 — Moderna
2022-04-28
Survey response — 12 months, dose 2
MedDRA: Musculoskeletal pain, Office visit, Sciatica — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Increased sciatic pain in buttocks · Healthcare visit (other): Chiropractor

MedDRA releases: 2024-11 · check-in free text available
2022-04-28
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

1 call case(s)
2022-04-29
Call successful
Participant prefers to complete VAERS report online
2022-09-21
Dose 4 — Pfizer-BioNTech
2022-09-22
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-09-23
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-09-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-09-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-09-27
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2022-09-28
Health check-in — day 7, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-10-05
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-12
Survey response — day 21, dose 4
MedDRA: Cough, Nasopharyngitis — Feeling: Fair

Free text: I have a cold (cough mainly). Haven't tested myself but tested my daughter twice (COVID negative) and believe I got it from her

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-26
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-02
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-21
Survey response — 3 months, dose 4
MedDRA: COVID-19, Streptococcal infection — Feeling: Fair

Free text: COVID. Now currently suspecting strep

MedDRA releases: 2024-11 · check-in free text available
2023-03-22
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-07	Pfizer-BioNTech
2	2021-04-28	Pfizer-BioNTech
3	2021-11-27	Moderna	No
4	2022-09-21	Pfizer-BioNTech	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 8 — days 1–6 daily, dose 2

2021-05-01

Systemic reaction (other): Eyes have mild pain when I move them side to side or up and down quickly or hold them in a position other than straight forward

2021-05-02

Systemic reaction (other): Eyes are still bothering me whenever I move them within the socket (e.g. when I look left or right, up or down). Prevents me from performing some activities

2021-05-03

Systemic reaction (other): Eye pain

2021-05-04

Systemic reaction (other): Still having eye discomfort/pain but its better today than yesterday

Release 8 — day 7, dose 2

2021-05-05

Systemic reaction (other): Eye discomfort still persists but is finally getting better!

Release 8 — day 21, dose 2

2021-05-19

Symptoms: Back (lumbar) pain, primarily when sitting, started about the same day as last check-in but I didnt think to note it then. Its a feeling Ive never had before and I cant attribute it to anything other than, likely, the vaccine.

Release 11 — 12 months, dose 2

2022-04-28

Symptoms: Increased sciatic pain in buttocks

Healthcare visit (other): Chiropractor

Release 12 — day 21, dose 4

2022-10-12

Symptoms: I have a cold (cough mainly). Haven't tested myself but tested my daughter twice (COVID negative) and believe I got it from her

Release 12 — 3 months, dose 4

2022-12-21

Symptoms: COVID. Now currently suspecting strep

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	Back pain	✓	✓	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Musculoskeletal pain	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Sciatica	·	·	✓
SD	Streptococcal infection	·	·	✓
SRO	Eye movement disorder	✓	✓	✓
SRO	Eye pain	✓	✓	✓
SRO	Loss of personal independence in daily activities	✓	✓	✓
SRO	Ocular discomfort	✓	✓	✓
SRO	Pain	✓	✓	✓

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