5UM-25113-40566

3 vaccinations 16 coded responses 30 check-ins 15 free-text entries 0 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 945 / CA
Registered: 2021-08-26

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

Registered dependents

8JA-22719-35067 Adult relative or friend · Female · 2021-08-28

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-08-26
Registered in v-safe
2021-08-26
Dose 1 — Pfizer-BioNTech
2021-08-26
Health check-in — day 0, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-08-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2021-08-28
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2021-08-29
Survey response — days 1–6 daily, dose 1
MedDRA: Balance disorder, Dizziness — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Dizzy and off-balance.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-31
Survey response — days 1–6 daily, dose 1
MedDRA: Balance disorder, Dizziness — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Dizzy and off-balance

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-01
Survey response — days 1–6 daily, dose 1
MedDRA: Ageusia, Anosmia, Asthenia, Balance disorder, Dizziness — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Dizzy, off-balance, no endurance, no smell/no taste

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-05
Survey response — day 7, dose 1
MedDRA: Balance disorder, Dizziness, Fatigue — Feeling: Fair · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Dizzy, off balance, fatigue with any kind of activity.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-10
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-09-16
Dose 2 — Pfizer-BioNTech
2021-09-16
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-09-17
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Fatigue, Lethargy, Visual impairment — Feeling: Fair · Site: Pain · 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 see spots, lethargic, dizzy, tired

MedDRA releases: 2024-11 · check-in free text available
2021-09-18
Survey response — days 1–6 daily, dose 2
MedDRA: Photopsia, Visual impairment, Vitreous floaters — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: My vision is acting differently. Spots, dust floating in my path of vision, flashes of light around the perimeter of my vision.

MedDRA releases: 2024-11 · check-in free text available
2021-09-19
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Dizziness, Fatigue, Metamorphopsia, Visual impairment — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Dizzy and off-balance, spots and abstract patterns in vision, had good sleep so the fatigue is less today.

MedDRA releases: 2024-11 · check-in free text available
2021-09-20
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Dizziness, Eye disorder, Foreign body in eye, Visual impairment — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Dizzy and off-balance. Spots and zingers, dust in eye is very prominent

MedDRA releases: 2024-11 · check-in free text available
2021-09-21
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Balance disorder, Dizziness, Visual impairment — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Dizzy and off-balance, eye sight altered, upon awakening my energy burns fast.

MedDRA releases: 2024-11 · check-in free text available
2021-09-23
Survey response — day 7, dose 2
MedDRA: Asthenia, Balance disorder, Dizziness, Photopsia, Visual impairment — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Dizzy and off-balance, very little energy. Eyes seeing spots, fuzzy shapes perimeter flashes.

MedDRA releases: 2024-11 · check-in free text available
2021-09-30
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-10-08
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-10-14
Survey response — day 28, dose 2
MedDRA: Balance disorder, Fatigue, Muscular weakness, Photopsia, Visual impairment — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Eyes-sees spots, some inside circles, and perimeter flashes. Both arms feel weak and rubber-like occasionally. Fatigued. Off balance.

MedDRA releases: 2024-11 · check-in free text available
2021-10-21
Survey response — day 35, dose 2
MedDRA: Balance disorder, Brain fog, Fatigue, Vision blurred — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Foggy eyes, brain fog, off-balance, fatigue

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Survey response — day 42, dose 2
MedDRA: Decreased appetite, Diarrhoea, Emergency care, Gastroenteritis viral, Nausea, Pain, Pyrexia, Unevaluable event — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Fever, diarrhea, loss of appetite, severe nausea in stomach (confirmed by ER professionals), sickly pain all over, pain level was 9/10. The professionals called it this syndrome; stomach virus.

MedDRA releases: 2024-11 · check-in free text available
2021-12-16
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2022-03-17
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-04-19
Dose 3 — Pfizer-BioNTech
2022-05-01
Health check-in — day 7, dose 3
Feeling: Fair · Site: Pain · None · Be unable to do your normal daily activities

Adult check-in
2022-05-03
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2022-05-10
Survey response — day 21, dose 3
MedDRA: Arthralgia, Asthenia, Brain fog, Decreased appetite, Diarrhoea, Musculoskeletal pain, Myalgia, Neuralgia, Pain in extremity, Unevaluable event — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Muscle and nerve pain, both shoulders and arm, knee, hamstring, glute. Still suffering from equilibrium and endurance weaknesses and brain fog. Some diarrhea and appetite loss. Given more medication from PCP as well as prescribed physical therapy.

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2022-05-24
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2022-05-31
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-07-19
Survey response — 3 months, dose 3
MedDRA: Arthralgia, Pain in extremity, Sciatica — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Leg pain right sciatica, hamstring and knee. After walking @10 minutes and/or standing in place brings on that type of pain.

MedDRA releases: 2024-11 · check-in free text available
2023-04-21
Survey response — 12 months, dose 3
MedDRA: Prostate cancer — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-08-26	Pfizer-BioNTech	No
2	2021-09-16	Pfizer-BioNTech	No
3	2022-04-19	Pfizer-BioNTech	No

Free text

Release 9 — days 1–6 daily, dose 1

2021-08-29

Systemic reaction (other): Dizzy and off-balance.

2021-08-31

Systemic reaction (other): Dizzy and off-balance

2021-09-01

Systemic reaction (other): Dizzy, off-balance, no endurance, no smell/no taste

Release 9 — day 7, dose 1

2021-09-05

Systemic reaction (other): Dizzy, off balance, fatigue with any kind of activity.

Release 9 — days 1–6 daily, dose 2

2021-09-17

Systemic reaction (other): I see spots, lethargic, dizzy, tired

2021-09-18

Systemic reaction (other): My vision is acting differently. Spots, dust floating in my path of vision, flashes of light around the perimeter of my vision.

2021-09-19

Systemic reaction (other): Dizzy and off-balance, spots and abstract patterns in vision, had good sleep so the fatigue is less today.

2021-09-20

Systemic reaction (other): Dizzy and off-balance. Spots and zingers, dust in eye is very prominent

2021-09-21

Systemic reaction (other): Dizzy and off-balance, eye sight altered, upon awakening my energy burns fast.

Release 9 — day 7, dose 2

2021-09-23

Systemic reaction (other): Dizzy and off-balance, very little energy. Eyes seeing spots, fuzzy shapes perimeter flashes.

Release 10 — day 28, dose 2

2021-10-14

Symptoms: Eyes-sees spots, some inside circles, and perimeter flashes. Both arms feel weak and rubber-like occasionally. Fatigued. Off balance.

Release 10 — day 35, dose 2

2021-10-21

Symptoms: Foggy eyes, brain fog, off-balance, fatigue

Release 10 — day 42, dose 2

2021-10-28

Symptoms: Fever, diarrhea, loss of appetite, severe nausea in stomach (confirmed by ER professionals), sickly pain all over, pain level was 9/10. The professionals called it this syndrome; stomach virus.

Release 11 — day 21, dose 3

2022-05-10

Symptoms: Muscle and nerve pain, both shoulders and arm, knee, hamstring, glute. Still suffering from equilibrium and endurance weaknesses and brain fog. Some diarrhea and appetite loss. Given more medication from PCP as well as prescribed physical therapy. cut off by CDC

Release 12 — 3 months, dose 3

2022-07-19

Symptoms: Leg pain right sciatica, hamstring and knee. After walking @10 minutes and/or standing in place brings on that type of pain.

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
SD	Arthralgia	·	·	✓
SD	Asthenia	·	·	✓
SD	Balance disorder	·	·	✓
SD	Brain fog	·	·	✓
SD	Decreased appetite	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Emergency care	·	·	✓
SD	Fatigue	·	·	✓
SD	Gastroenteritis viral	·	·	✓
SD	Muscular weakness	·	·	✓
SD	Musculoskeletal pain	·	·	✓
SD	Myalgia	·	·	✓
SD	Nausea	·	·	✓
SD	Neuralgia	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Photopsia	·	·	✓
SD	Prostate cancer	·	·	✓
SD	Pyrexia	·	·	✓
SD	Sciatica	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Vision blurred	·	·	✓
SD	Visual impairment	·	·	✓
SRO	Ageusia	✓	·	✓
SRO	Anosmia	✓	·	✓
SRO	Asthenia	✓	·	✓
SRO	Balance disorder	✓	·	✓
SRO	Dizziness	✓	·	✓
SRO	Eye disorder	·	·	✓
SRO	Fatigue	✓	·	✓
SRO	Foreign body in eye	·	·	✓
SRO	Lethargy	·	·	✓
SRO	Metamorphopsia	·	·	✓
SRO	Photopsia	·	·	✓
SRO	Visual impairment	·	·	✓
SRO	Vitreous floaters	·	·	✓

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