5U6-15179-57319

2 vaccinations 11 coded responses 17 check-ins 11 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 190 / PA
Registered: 2021-05-02

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

2021-05-01
Dose 1 — Janssen/Johnson & Johnson
2021-05-02
Registered in v-safe
2021-05-02
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate irregular — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: PVCS/ irregular heartbeat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Urinary hesitation — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Free text: Dizziness; more than usual hesitation in urinating

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Urinary hesitation — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Hesitant urination; dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Dysuria — Feeling: Fair · Site: Itching · Muscle or body aches, Fatigue or tiredness

Free text: Very dizzy. Still some urination difficulty

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Itching · Muscle or body aches, Nausea

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-05-08
Health check-in — day 7, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-05-15
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-05-22
Health check-in — day 21, single dose
Feeling: Fair

Adult check-in
2021-05-29
Health check-in — day 28, single dose
Feeling: Good

Adult check-in
2021-06-05
Health check-in — day 35, single dose
Feeling: Good

Adult check-in
2021-06-12
Survey response — day 42, single dose
MedDRA: Arthralgia, Asthenia, Back pain, Fatigue, Myalgia, Pain, Pain in extremity, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: For the past 3 or 4 days I have been so tired that I can barely do the basics. Besides my lack of energy I have had more aches and pains than usual. The Worsening aches are in my Lower Back and legs & in my hip where I had hip replaced 6 yrs. ago.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-31
Survey response — 3 months, dose 1
MedDRA: Asthenia, Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Since I received the COVID Vaccine I have been so tired all the time. I was never without energy like I have been for the past 3 months. I didnt equate this condition to the vaccine before but now I can see no other explanation.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-30
Survey response — 6 months, dose 1
MedDRA: Headache, Nausea, Pain, Pyrexia, SARS-CoV-2 test negative, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Nausea, vomiting, fever for 2 days, aches and headaches. Some of the Symptoms lasted about 2 weeks. I had a COVID-19 test and the result was negative.

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Dose 2 — Pfizer-BioNTech
Co-administered: Flu
2022-02-09
Survey response — 3 months, dose 2
MedDRA: Fatigue, Malaise, Pruritus, Vaccination site mass, Ventricular extrasystoles — Feeling: Fair · Be unable to do your normal daily activities

Free text: Extremely tired all the time; general feeling of not being well; heart pvcs. I don't know if these symptoms are related to the Covid vaccine but I have felt worse since having it. I still have an itchy upper arm & lump at the vaccination site.

MedDRA releases: 2024-11 · check-in free text available
2022-05-10
Survey response — 6 months, dose 2
MedDRA: Heart rate irregular, Injection site pruritus, Office visit, Ventricular extrasystoles — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Irregular heartbeat for unknown reason. Cardiologist advised that I am suffering with numerous PVC's and prescribed a beta blocker. Upper arm still itches terribly where I received last Covid booster injection. · Healthcare visit (other): Went to cardiologist.

MedDRA releases: 2024-11 · check-in free text available
2022-05-10
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-11
Call 1 — Left Voicemail
2022-11-09
Survey response — 12 months, dose 2
MedDRA: Office visit, Ventricular extrasystoles — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Since last Covid booster I have had daily PVC's. The premature contractions began several weeks after receiving the vaccine. I Saw cardiologist who prescribed beta blocker that reduces PVC's. It's Unknown if vaccine & irregular heartbeat is related. · Healthcare visit (other): Cardiologist Appointment

MedDRA releases: 2024-11 · check-in free text available
2022-11-09
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-10
Call 2 — Left Voicemail
2022-11-10
Call 1 — Left Voicemail
2022-11-11
Call 3 — Left Voicemail
2022-11-11
Call 2 — Left Voicemail
2022-11-30
Call successful
Participant prefers to complete VAERS report online
2022-11-30
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-01	Janssen/Johnson & Johnson
2	2021-11-09	Pfizer-BioNTech	Flu

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 8 — days 1–6 daily, dose 1

2021-05-02

Systemic reaction (other): PVCS/ irregular heartbeat

2021-05-03

Systemic reaction (other): Dizziness; more than usual hesitation in urinating

2021-05-04

Systemic reaction (other): Hesitant urination; dizziness

2021-05-05

Systemic reaction (other): Very dizzy. Still some urination difficulty

2021-05-06

Systemic reaction (other): Dizziness

Release 9 — day 42, single dose

2021-06-12

Symptoms: For the past 3 or 4 days I have been so tired that I can barely do the basics. Besides my lack of energy I have had more aches and pains than usual. The Worsening aches are in my Lower Back and legs & in my hip where I had hip replaced 6 yrs. ago. cut off by CDC

Release 9 — 3 months, dose 1

2021-07-31

Symptoms: Since I received the COVID Vaccine I have been so tired all the time. I was never without energy like I have been for the past 3 months. I didnt equate this condition to the vaccine before but now I can see no other explanation.

Release 10 — 6 months, dose 1

2021-10-30

Symptoms: Nausea, vomiting, fever for 2 days, aches and headaches. Some of the Symptoms lasted about 2 weeks. I had a COVID-19 test and the result was negative.

Release 11 — 3 months, dose 2

2022-02-09

Symptoms: Extremely tired all the time; general feeling of not being well; heart pvcs. I don't know if these symptoms are related to the Covid vaccine but I have felt worse since having it. I still have an itchy upper arm & lump at the vaccination site.

Release 11 — 6 months, dose 2

2022-05-10

Symptoms: Irregular heartbeat for unknown reason. Cardiologist advised that I am suffering with numerous PVC's and prescribed a beta blocker. Upper arm still itches terribly where I received last Covid booster injection.

Healthcare visit (other): Went to cardiologist.

Release 12 — 12 months, dose 2

2022-11-09

Symptoms: Since last Covid booster I have had daily PVC's. The premature contractions began several weeks after receiving the vaccine. I Saw cardiologist who prescribed beta blocker that reduces PVC's. It's Unknown if vaccine & irregular heartbeat is related. cut off by CDC

Healthcare visit (other): Cardiologist Appointment

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	Arthralgia	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Heart rate irregular	·	·	✓
SD	Injection site pruritus	·	·	✓
SD	Malaise	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Nausea	·	·	✓
SD	Office visit	·	·	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pruritus	·	·	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Vaccination site mass	·	·	✓
SD	Ventricular extrasystoles	·	·	✓
SD	Vomiting	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Dysuria	✓	✓	✓
SRO	Heart rate irregular	✓	✓	✓
SRO	Urinary hesitation	✓	✓	✓

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