5EX-27176-27962

4 vaccinations 8 coded responses 17 check-ins 7 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 959 / CA
Registered: 2021-11-22

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

2021-02-23
Dose 1 — Pfizer-BioNTech
2021-03-17
Dose 2 — Pfizer-BioNTech
2021-11-22
Registered in v-safe
2021-11-22
Dose 3 — Pfizer-BioNTech
2021-11-22
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-23
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-11-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-11-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-26
Survey response — days 1–6 daily, dose 3
MedDRA: Breast tenderness — Feeling: Fair · Site: Pain

Free text: Breast tenderness

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-29
Survey response — day 7, dose 3
MedDRA: Blood glucose increased — Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Free text: For the last several days my blood sugar has been higher than normal. Until today I hadn't connected this to the vaccine. Perhaps it is related???

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-13
Survey response — day 21, dose 3
MedDRA: Arthralgia, Muscle spasms, Pain, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: My arm, though I thought it was improving, still hurts and sometimes throbs. It's like the muscle into which the vaccine was given keeps cramping or something. Sometimes, my entire shoulder aches.

MedDRA releases: 2024-11 · check-in free text available
2021-12-20
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-27
Survey response — day 35, dose 3
MedDRA: Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: I keep hoping my arm is getting better and I ignore the pain but over the last week it has gotten very painful.

MedDRA releases: 2024-11 · check-in free text available
2022-01-03
Survey response — day 42, dose 3
MedDRA: Arthralgia, Neck pain, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Arm, shoulder and neck pain.

MedDRA releases: 2024-11 · check-in free text available
2022-02-21
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-05-23
Survey response — 6 months, dose 3
MedDRA: COVID-19 — Feeling: Fair · Be unable to do your normal daily activities

Free text: Covid 19

MedDRA releases: 2024-11 · check-in free text available
2022-11-22
Survey response — 12 months, dose 3
MedDRA: Abdominal pain upper, Fear, Gastrointestinal motility disorder, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Stomach pain and bowel changes. Medical tests have shown no cause. Required a breast biopsy. More women than seem normal are requiring the same thing. Test came back benign but still scary and tough to go through. · Healthcare visit (other): Primary care visit; lab tests, sonogram, biopsy

MedDRA releases: 2024-11 · check-in free text available
2022-11-22
Report sent to call center — 12 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-23
Call 1 — Left Voicemail
2022-11-23
Call successful
Does not wish to fill out VAERS report
2022-12-20
Dose 4 — Pfizer-BioNTech
2023-06-20
Survey response — 6 months, dose 4
MedDRA: Hypertension, Rash, Self-medication — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-23	Pfizer-BioNTech	No
2	2021-03-17	Pfizer-BioNTech	No
3	2021-11-22	Pfizer-BioNTech	No
4	2022-12-20	Pfizer-BioNTech	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 10 — days 1–6 daily, dose 3

2021-11-26

Systemic reaction (other): Breast tenderness

Release 10 — day 7, dose 3

2021-11-29

Systemic reaction (other): For the last several days my blood sugar has been higher than normal. Until today I hadn't connected this to the vaccine. Perhaps it is related???

Release 10 — day 21, dose 3

2021-12-13

Symptoms: My arm, though I thought it was improving, still hurts and sometimes throbs. It's like the muscle into which the vaccine was given keeps cramping or something. Sometimes, my entire shoulder aches.

Release 10 — day 35, dose 3

2021-12-27

Symptoms: I keep hoping my arm is getting better and I ignore the pain but over the last week it has gotten very painful.

Release 10 — day 42, dose 3

2022-01-03

Symptoms: Arm, shoulder and neck pain.

Release 11 — 6 months, dose 3

2022-05-23

Symptoms: Covid 19

Release 12 — 12 months, dose 3

2022-11-22

Symptoms: Stomach pain and bowel changes. Medical tests have shown no cause. Required a breast biopsy. More women than seem normal are requiring the same thing. Test came back benign but still scary and tough to go through.

Healthcare visit (other): Primary care visit; lab tests, sonogram, biopsy

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	Abdominal pain upper	·	·	✓
SD	Arthralgia	·	·	✓
SD	COVID-19	·	·	✓
SD	Fear	·	·	✓
SD	Gastrointestinal motility disorder	·	·	✓
SD	Hypertension	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Neck pain	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Rash	·	·	✓
SD	Self-medication	·	·	✓
SRO	Blood glucose increased	·	·	✓
SRO	Breast tenderness	·	·	✓

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