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5TC-12448-97760

4 vaccinations 21 coded responses 39 check-ins 20 free-text entries 2 call cases
Sex
Male
Age at first dose
66+
ZIP prefix
930 / CA
Registered
2021-01-22
Relationship
Self
Race
N/A
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-21
    Dose 1 — Pfizer-BioNTech
  2. 2021-01-22
    Registered in v-safe
  3. 2021-01-22
    Survey response — days 1–6 daily, dose 1
    MedDRA: Headache — Feeling: Good · Site: Pain · Headache
    Free text: I do not believe headache was from shot.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-01-24
    Survey response — days 1–6 daily, dose 1
    MedDRA: Arthralgia — Feeling: Good · Joint pains
    Free text: Right hip pain.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-01-25
    Survey response — days 1–6 daily, dose 1
    MedDRA: Back pain — Feeling: Good
    Free text: Unrelated back pain.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-01-26
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-01-27
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-01-28
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-02-04
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  10. 2021-02-11
    Dose 2 — Pfizer-BioNTech
  11. 2021-02-11
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  12. 2021-02-12
    Survey response — days 1–6 daily, dose 2
    MedDRA: Sluggishness — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches
    Free text: Sluggish in movements
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-02-13
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  14. 2021-02-14
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  15. 2021-02-16
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  16. 2021-02-18
    Survey response — day 7, dose 2
    MedDRA: Back pain — Feeling: Good · Headache
    Free text: Back ache on lower right side.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-02-25
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  18. 2021-03-05
    Survey response — day 21, dose 2
    MedDRA: Arthralgia, Back pain — Feeling: Good
    Free text: Lower right side hip and back pain.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-03-12
    Survey response — day 28, dose 2
    MedDRA: Anxiety, Dizziness, Feeling abnormal, Headache, Pre-existing disease, Sinus congestion — Feeling: Good
    Free text: Anxiety, dizziness, headaches, sinus congestion, bad feeling all over primarily due to my SIBO (Small intestinal Bacterial Over Growth) condition.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  20. 2021-03-19
    Survey response — day 35, dose 2
    MedDRA: Constipation, Gastrointestinal bacterial overgrowth, Headache, Pain in extremity, Sinus congestion — Feeling: Fair
    Free text: Headache, Sinus Congestion, Constipation, sore shot arm when I sleep on it and SIBO attact.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  21. 2021-03-25
    Health check-in — day 42, dose 2
    Feeling: Fair
    Adult check-in
  22. 2021-08-13
    Survey response — 6 months, dose 2
    MedDRA: Condition aggravated, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities
    Free text: SIBO Attacks.
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  23. 2021-10-12
    Dose 3 — Pfizer-BioNTech
  24. 2021-10-13
    Survey response — days 1–6 daily, dose 3
    MedDRA: Back pain — Feeling: Good · Site: Pain · Muscle or body aches
    Free text: Lower right side back ache.
    MedDRA releases: 2024-11 · check-in free text available
  25. 2021-10-15
    Survey response — days 1–6 daily, dose 3
    MedDRA: Balance disorder — Feeling: Good · Muscle or body aches, Rash, not including the immediate area around the injection site
    Free text: Balance control
    MedDRA releases: 2024-11 · check-in free text available
  26. 2021-10-16
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Abdominal pain, Rash, not including the immediate area around the injection site
    Adult check-in
  27. 2021-10-18
    Survey response — days 1–6 daily, dose 3
    MedDRA: Dizziness — Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site
    Free text: Dizziness
    MedDRA releases: 2024-11 · check-in free text available
  28. 2021-10-19
    Survey response — day 7, dose 3
    MedDRA: Balance disorder, Dizziness, Vision blurred — Feeling: Fair · Joint pains, Fatigue or tiredness, Rash, not including the immediate area around the injection site
    Free text: Dizziness, Off balance, Blurry vision
    MedDRA releases: 2024-11 · check-in free text available
  29. 2021-10-26
    Health check-in — day 14, dose 3
    Feeling: Fair
    Adult check-in
  30. 2021-11-04
    Survey response — day 21, dose 3
    MedDRA: Abdominal pain upper, Anxiety, Back pain — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Back pain, anxiety, stomach aches.
    MedDRA releases: 2024-11 · check-in free text available
  31. 2021-11-10
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  32. 2021-11-17
    Survey response — day 35, dose 3
    MedDRA: Abdominal pain upper, Headache — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities
    Free text: Stomach and headache pain. Headache level 7. Stomach level 4.
    MedDRA releases: 2024-11 · check-in free text available
  33. 2021-11-23
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  34. 2022-04-14
    Survey response — 6 months, dose 3
    MedDRA: Condition aggravated, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities
    Free text: Bad SIBO attacks!
    MedDRA releases: 2024-11 · check-in free text available
  35. 2022-05-05
    Dose 4 — Moderna
  36. 2022-05-16
    Survey response — day 7, dose 4
    MedDRA: Abdominal pain upper — Feeling: Poor · Fever · Headache · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Stomach ache
    MedDRA releases: 2024-11 · check-in free text available
  37. 2022-05-16
    Report sent to call center — day 7, dose 4
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  38. 2022-05-17
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  39. 2022-05-19
    Health check-in — day 14, dose 4
    Feeling: Good
    Adult check-in
  40. 2022-05-27
    Health check-in — day 21, dose 4
    Feeling: Good
    Adult check-in
  41. 2022-06-02
    Survey response — day 28, dose 4
    MedDRA: Anxiety, Headache — Feeling: Poor · Be unable to do your normal daily activities
    Free text: Severe headache, anxiety
    MedDRA releases: 2024-11 · check-in free text available
  42. 2022-06-15
    Health check-in — day 35, dose 4
    Feeling: Good
    Adult check-in
  43. 2022-06-16
    Health check-in — day 42, dose 4
    Feeling: Good
    Adult check-in
  44. 2022-08-05
    Survey response — 3 months, dose 4
    MedDRA: Gastrointestinal disorder — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Stomach problems.
    MedDRA releases: 2024-11 · check-in free text available
  45. 2022-08-05
    Report sent to call center — 3 months, dose 4
    Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  46. 2022-08-08
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  47. 2022-11-03
    Survey response — 6 months, dose 4
    MedDRA: Anxiety, Fall, Gastrointestinal bacterial overgrowth, Limb injury, Stress — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Stress, anxiety, SIBO symptoms. Left shoulder sprained from fall from stairs.
    MedDRA releases: 2024-11 · check-in free text available
  48. 2023-05-05
    Survey response — 12 months, dose 4
    MedDRA: Abdominal pain upper, Arthralgia, Depressed mood, Depression, Dizziness, Fall, Gastrointestinal bacterial overgrowth, Grief reaction, Headache, Stress — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities
    MedDRA releases: 2024-11

Vaccinations

DoseDateManufacturerCo-administered
12021-01-21Pfizer-BioNTech
22021-02-11Pfizer-BioNTech
32021-10-12Pfizer-BioNTech No
42022-05-05Moderna No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-22

Systemic reaction (other): I do not believe headache was from shot.

2021-01-24

Systemic reaction (other): Right hip pain.

2021-01-25

Systemic reaction (other): Unrelated back pain.

Release 4 — days 1–6 daily, dose 2

2021-02-12

Systemic reaction (other): Sluggish in movements

Release 4 — day 7, dose 2

2021-02-18

Systemic reaction (other): Back ache on lower right side.

Release 5 — day 21, dose 2

2021-03-05

Symptoms: Lower right side hip and back pain.

Release 5 — day 28, dose 2

2021-03-12

Symptoms: Anxiety, dizziness, headaches, sinus congestion, bad feeling all over primarily due to my SIBO (Small intestinal Bacterial Over Growth) condition.

Release 6 — day 35, dose 2

2021-03-19

Symptoms: Headache, Sinus Congestion, Constipation, sore shot arm when I sleep on it and SIBO attact.

Release 9 — 6 months, dose 2

2021-08-13

Symptoms: SIBO Attacks.

Release 10 — days 1–6 daily, dose 3

2021-10-13

Systemic reaction (other): Lower right side back ache.

2021-10-15

Systemic reaction (other): Balance control

2021-10-18

Systemic reaction (other): Dizziness

Release 10 — day 7, dose 3

2021-10-19

Systemic reaction (other): Dizziness, Off balance, Blurry vision

Release 10 — day 21, dose 3

2021-11-04

Symptoms: Back pain, anxiety, stomach aches.

Release 10 — day 35, dose 3

2021-11-17

Symptoms: Stomach and headache pain. Headache level 7. Stomach level 4.

Release 11 — 6 months, dose 3

2022-04-14

Symptoms: Bad SIBO attacks!

Release 11 — day 7, dose 4

2022-05-16

Systemic reaction (other): Stomach ache

Release 11 — day 28, dose 4

2022-06-02

Symptoms: Severe headache, anxiety

Release 12 — 3 months, dose 4

2022-08-05

Symptoms: Stomach problems.

Release 12 — 6 months, dose 4

2022-11-03

Symptoms: Stress, anxiety, SIBO symptoms. Left shoulder sprained from fall from stairs.

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

FieldPreferred term2021-092023-042024-11
SDAbdominal pain upper · · ✓
SDAnxiety ✓ ✓ ✓
SDArthralgia ✓ ✓ ✓
SDBack pain ✓ ✓ ✓
SDCondition aggravated ✓ · ✓
SDConstipation ✓ ✓ ✓
SDDepressed mood · · ✓
SDDepression · · ✓
SDDizziness ✓ ✓ ✓
SDFall · · ✓
SDFeeling abnormal ✓ ✓ ✓
SDGastrointestinal bacterial overgrowth ✓ ✓ ✓
SDGastrointestinal disorder · · ✓
SDGrief reaction · · ✓
SDHeadache ✓ ✓ ✓
SDLimb injury · · ✓
SDPain in extremity ✓ ✓ ✓
SDPre-existing disease ✓ ✓ ✓
SDSinus congestion ✓ ✓ ✓
SDStress · · ✓
SROAbdominal pain upper · · ✓
SROArthralgia ✓ ✓ ✓
SROBack pain ✓ ✓ ✓
SROBalance disorder · · ✓
SRODizziness · · ✓
SROHeadache ✓ ✓ ✓
SROSluggishness ✓ ✓ ✓
SROVision blurred · · ✓

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

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