5KL-67182-49170

3 vaccinations 9 coded responses 17 check-ins 9 free-text entries 1 call case

Sex: Female
Age at first dose: 36-40
ZIP prefix: 021 / MA
Registered: 2021-03-17

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

Registered dependents

QSF-30289-99070 Other · Female · 2021-07-05

Timeline

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

2021-03-15
Dose 1 — Pfizer-BioNTech
2021-03-17
Registered in v-safe
2021-03-17
Survey response — days 1–6 daily, dose 1
MedDRA: Anosmia, Condition aggravated, Fatigue, Paranasal sinus discomfort, Pre-existing disease, Sinus disorder, Swelling face — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Sinus pressure & swelling - I have Fibromyalgia and chronic systemic inflammation (likely SLE Lupus). The facial & sinus swelling was triggered by the vaccine. The first morning after, it was severe enough that I lost my sense of smell for the day. This is the following day, and the area around my eyes is no longer swollen, I've regained most of my sense of smell, but do still have increased sinus pressure and swelling. I believe the vaccine temporary flaired up the autoimmune response. I also believe my fatigue is more related to the vaccine flairing up the chronic fatigue element of my Fibromyalgia, than directly related to the vaccine itself. Today, it is moderate, but yesterday it was severe.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Survey response — day 14, dose 1
MedDRA: Adverse reaction, Fall, Forearm fracture — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: I fell and fractured my radius and ulna bones at my wrist Wed night after my first shot (Mon). Hence not reporting. I couldn't differentiate symptoms. I don't believe there was any more of a reaction than reported. ENT sx abated by Thurs/Fri.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Dose 2 — Pfizer-BioNTech
2021-04-05
Survey response — day 0, dose 2
MedDRA: Emergency care, Limb injury, Pre-existing disease — 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

Free text: Systemic reaction (other): Broken Arm, Fibromyalgia · Healthcare visit (other): Future Outpatient Orthopedic Surgeon Visit - post ER

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Report sent to call center — day 0, dose 2
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)
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Chills, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-04-10
Survey response — days 1–6 daily, dose 2
MedDRA: Oropharyngeal pain, Paranasal sinus discomfort, Paranasal sinus inflammation — Feeling: Poor · Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Sore throat, sinus pressure & inflammation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Fever · Headache, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-12
Health check-in — day 7, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-19
Survey response — day 14, dose 2
MedDRA: Migraine, Pre-existing disease — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Migraine episode, likely weather related (pre-existing chronic condition)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-07-05
Survey response — 3 months, dose 2
MedDRA: Fatigue, Injection site pain, Oropharyngeal pain — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Fatigue, sore throat, injection muscle pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-12-20
Dose 3 — Moderna
2022-01-02
Survey response — day 7, dose 3
MedDRA: Fatigue, Malaise, Pre-existing disease, Sinusitis — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I was sick with a sinus infection type sx and fatigue/malaise for 4 days after the shot. My current SX are due to my Fibromyalgia.

MedDRA releases: 2024-11 · check-in free text available
2022-01-03
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2022-01-20
Survey response — day 28, dose 3
MedDRA: Sinusitis — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Sinusitis, no Covid

MedDRA releases: 2024-11 · check-in free text available
2022-01-24
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2022-03-18
Call 1 — Left Voicemail
2022-03-18
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-03-25
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-12-23
Survey response — 12 months, dose 3
MedDRA: Ligament disorder, Tendon disorder — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: New combo booster caused Levaquin-type tightness of tendons & ligaments for a week.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-15	Pfizer-BioNTech
2	2021-04-05	Pfizer-BioNTech
3	2021-12-20	Moderna	No

Call center

1 call center case

1 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-17

Systemic reaction (other): Sinus pressure & swelling - I have Fibromyalgia and chronic systemic inflammation (likely SLE Lupus). The facial & sinus swelling was triggered by the vaccine. The first morning after, it was severe enough that I lost my sense of smell for the day. This is the following day, and the area around my eyes is no longer swollen, I've regained most of my sense of smell, but do still have increased sinus pressure and swelling. I believe the vaccine temporary flaired up the autoimmune response. I also believe my fatigue is more related to the vaccine flairing up the chronic fatigue element of my Fibromyalgia, than directly related to the vaccine itself. Today, it is moderate, but yesterday it was severe.

Release 6 — day 14, dose 1

2021-03-29

Symptoms: I fell and fractured my radius and ulna bones at my wrist Wed night after my first shot (Mon). Hence not reporting. I couldn't differentiate symptoms. I don't believe there was any more of a reaction than reported. ENT sx abated by Thurs/Fri.

Release 6 — day 0, dose 2

2021-04-05

Systemic reaction (other): Broken Arm, Fibromyalgia

Healthcare visit (other): Future Outpatient Orthopedic Surgeon Visit - post ER

Release 7 — days 1–6 daily, dose 2

2021-04-10

Systemic reaction (other): Sore throat, sinus pressure & inflammation

Release 7 — day 14, dose 2

2021-04-19

Symptoms: Migraine episode, likely weather related (pre-existing chronic condition)

Release 9 — 3 months, dose 2

2021-07-05

Symptoms: Fatigue, sore throat, injection muscle pain

Release 10 — day 7, dose 3

2022-01-02

Systemic reaction (other): I was sick with a sinus infection type sx and fatigue/malaise for 4 days after the shot. My current SX are due to my Fibromyalgia.

Release 10 — day 28, dose 3

2022-01-20

Symptoms: Sinusitis, no Covid

Release 12 — 12 months, dose 3

2022-12-23

Symptoms: New combo booster caused Levaquin-type tightness of tendons & ligaments for a week.

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	Emergency care	✓	✓	✓
SD	Adverse reaction	✓	✓	✓
SD	Fall	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Forearm fracture	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Ligament disorder	·	·	✓
SD	Migraine	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Sinusitis	·	·	✓
SD	Tendon disorder	·	·	✓
SRO	Anosmia	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Limb injury	✓	✓	✓
SRO	Malaise	·	·	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Paranasal sinus discomfort	✓	✓	✓
SRO	Paranasal sinus inflammation	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Sinus disorder	✓	✓	✓
SRO	Sinusitis	·	·	✓
SRO	Swelling face	✓	✓	✓

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