5E7-22928-00592

2 vaccinations 5 coded responses 12 check-ins 5 free-text entries 5 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 722 / AR
Registered: 2020-12-29

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

2020-12-29
Registered in v-safe
2020-12-29
Dose 1 — Pfizer-BioNTech
2020-12-29
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2020-12-31
Survey response — days 1–6 daily, dose 1
MedDRA: Hospitalisation, Thrombosis — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, 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: Systemic reaction (other): Ä° have been hospitalized since the 30th die to an unrelated issue. · Healthcare visit (other): Ä° had blood clots in my lungs I'm related to the injection. Ä° Don't wish to continue with this study since Ä° need to concentrate on my other issues. Ä° will still get the 2nd ahot get

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-31
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-01
Survey response — days 1–6 daily, dose 1
MedDRA: Hospitalisation, Pre-existing disease, Unevaluable event — Feeling: Fair · Chills, Joint pains, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Systemic reaction (other): I have been hospitalized with an hereditary PE since Wednesday · Healthcare visit (other): I have a PE that appears to be hereditaryditary

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-01
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-02
Survey response — days 1–6 daily, dose 1
MedDRA: Pulmonary oedema — Feeling: Fair · Joint pains, Fatigue or tiredness, Nausea · Be unable to work, 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: Systemic reaction (other): Ä° was diagnosed with PE 1/30 · Healthcare visit (other): Ä° was diagnosed with PE

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-02
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-03
Survey response — days 1–6 daily, dose 1
MedDRA: Hospitalisation, Pulmonary embolism — Feeling: Fair · Joint pains, Fatigue or tiredness, Nausea · Be unable to work, 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: Systemic reaction (other): Was diagnosed and hospitalized with blood clots on my lungs 12/30/2020 · Healthcare visit (other): Was diagnosed and hospitalized with PE 12/30/2020

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-03
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-05
Survey response — day 7, dose 1
MedDRA: Hospitalisation, Pulmonary thrombosis — Feeling: Poor · Chills, Headache, Joint pains, Fatigue or tiredness, Nausea · Be unable to work, 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: Systemic reaction (other): On 1/30 was hospitalized with blood clotsinboth lungs · Healthcare visit (other): On 1/30 was hospitalized with blood clotsinboth lungs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-05
Report sent to call center — day 7, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-21
Dose 2 — Pfizer-BioNTech
2021-01-22
Call 1 — Left Voicemail
2021-02-02
Health check-in — day 7, dose 2
Feeling: Fair · None

Adult check-in
2021-02-04
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-02-13
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-02-18
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-07-24
Health check-in — 6 months, dose 2
Feeling: Poor

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-29	Pfizer-BioNTech
2	2021-01-21	Pfizer-BioNTech

Call center

5 call center cases

5 unsuccessful

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2020-12-31

Systemic reaction (other): Ä° have been hospitalized since the 30th die to an unrelated issue.

Healthcare visit (other): Ä° had blood clots in my lungs I'm related to the injection. Ä° Don't wish to continue with this study since Ä° need to concentrate on my other issues. Ä° will still get the 2nd ahot get

2021-01-01

Systemic reaction (other): I have been hospitalized with an hereditary PE since Wednesday

Healthcare visit (other): I have a PE that appears to be hereditaryditary

2021-01-02

Systemic reaction (other): Ä° was diagnosed with PE 1/30

Healthcare visit (other): Ä° was diagnosed with PE

2021-01-03

Systemic reaction (other): Was diagnosed and hospitalized with blood clots on my lungs 12/30/2020

Healthcare visit (other): Was diagnosed and hospitalized with PE 12/30/2020

Release 1 — day 7, dose 1

2021-01-05

Systemic reaction (other): On 1/30 was hospitalized with blood clotsinboth lungs

Healthcare visit (other): On 1/30 was hospitalized with blood clotsinboth lungs

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	Hospitalisation	✓	✓	✓
HCVO	Pre-existing disease	✓	·	✓
HCVO	Pulmonary embolism	✓	✓	✓
HCVO	Pulmonary oedema	✓	✓	✓
HCVO	Pulmonary thrombosis	✓	✓	✓
HCVO	Thrombosis	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SRO	Hospitalisation	✓	✓	✓
SRO	Pre-existing disease	✓	·	✓
SRO	Pulmonary embolism	✓	✓	✓
SRO	Pulmonary oedema	✓	✓	✓
SRO	Pulmonary thrombosis	✓	✓	✓
SRO	Unevaluable event	○	✓	○

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