5EN-67642-16091

1 vaccination 7 coded responses 13 check-ins 7 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 371 / TN
Registered: 2021-03-17

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

2021-03-17
Registered in v-safe
2021-03-17
Dose 1 — Pfizer-BioNTech
2021-03-17
Health check-in — day 0, dose 1
Feeling: Fair · None

Adult check-in
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Poor · Fatigue or tiredness

Free text: Mom is been not active and losing her strength. Dementia and not motivated. I dont think its because of shot. This has been going on

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Fair · Chills

Free text: Not sure if its due to weather

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · None

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · None

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-26
Survey response — day 7, dose 1
MedDRA: Dyspnoea, Hospitalisation — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Mom has been hospitalized we think due to allergy problems since Wednesday breathing problems. No Covid

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Report sent to call center — day 7, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-31
Health check-in — day 14, dose 1
Feeling: Poor

Adult check-in
2021-04-07
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-04-28
Survey response — day 42, dose 1
MedDRA: Hospitalisation, Pre-existing disease, Quarantine, Rehabilitation therapy — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Mom is in Rehab. Every time I try to get her shot she ends up @ hospital. She has liver problems. As soon as she is out of quarantine I will get her shot scheduled. She had no symptoms from 1st shot of Pfizer

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Report sent to call center — day 42, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-16
Survey response — 3 months, dose 1
MedDRA: Dementia, Headache — Feeling: Fair

Free text: Dementia. Headache for few days after second shot 6/10

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-16
Survey response — 6 months, dose 1
MedDRA: Hospice care, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: My mom is on Hospice due to liver disease · Healthcare visit (other): Hospice

MedDRA releases: 2024-11 · check-in free text available
2021-09-16
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

1 call case(s)
2021-09-17
Call 1 — Left Voicemail
2022-03-17
Survey response — 12 months, dose 1
MedDRA: Arthralgia, Bedridden, COVID-19, Hospice care, Muscle spasms — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Bedridden. Legs hips have cramps Had covid · Healthcare visit (other): Hospice

MedDRA releases: 2024-11 · check-in free text available
2022-03-17
Report sent to call center — 12 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2022-03-21
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-17	Pfizer-BioNTech

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-18

Systemic reaction (other): Mom is been not active and losing her strength. Dementia and not motivated. I dont think its because of shot. This has been going on

2021-03-19

Systemic reaction (other): Not sure if its due to weather

Release 6 — day 7, dose 1

2021-03-26

Systemic reaction (other): Mom has been hospitalized we think due to allergy problems since Wednesday breathing problems. No Covid

Release 8 — day 42, dose 1

2021-04-28

Symptoms: Mom is in Rehab. Every time I try to get her shot she ends up @ hospital. She has liver problems. As soon as she is out of quarantine I will get her shot scheduled. She had no symptoms from 1st shot of Pfizer

Release 9 — 3 months, dose 1

2021-06-16

Symptoms: Dementia. Headache for few days after second shot 6/10

Release 9 — 6 months, dose 1

2021-09-16

Symptoms: My mom is on Hospice due to liver disease

Healthcare visit (other): Hospice

Release 11 — 12 months, dose 1

2022-03-17

Symptoms: Bedridden. Legs hips have cramps Had covid

Healthcare visit (other): Hospice

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	Hospice care	·	·	✓
SD	Arthralgia	·	·	✓
SD	Bedridden	·	·	✓
SD	COVID-19	·	·	✓
SD	Dementia	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Muscle spasms	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Quarantine	·	·	✓
SD	Rehabilitation therapy	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Hospitalisation	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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