64J-10504-21056

3 vaccinations 5 coded responses 23 check-ins 5 free-text entries 3 call cases

Sex: Male
Age at first dose: 41-45
ZIP prefix: 843 / UT
Registered: 2021-03-01

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-03-01
Registered in v-safe
2021-03-01
Dose 1 — Pfizer-BioNTech
2021-03-01
Health check-in — day 0, dose 1
Feeling: Fair · Site: Itching · Fatigue or tiredness

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-22
Dose 2 — Pfizer-BioNTech
2021-03-22
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-09-20
Survey response — 6 months, dose 2
MedDRA: Gastric operation, Hiatus hernia, Medical counselling, Office visit, Pre-existing disease, Weight decreased — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: I'm disabled. I also had a stomach surgery, due to a large paraesophageal hiatal hernia, which was causing major problems, I have lost a lot of weight. None of it was/is related to Covid-10, in my view. I have never tested positive for Covid-19. · Healthcare visit (other): For mental health I am disabled over 20 years. I seenurse a mental health on telephone bi monthly. I see a mental health medicaiton provider several times a year, i see a therpaist many times a yr. I see my pcp a few times a year. I have seen Gastro

MedDRA releases: 2024-11 · check-in free text available
2021-09-20
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-09-23
Call 1 — Left Voicemail
2021-09-29
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2021-09-29
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-09-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-01
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
2021-10-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-03
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · None

Adult check-in
2021-10-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-10-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-10-06
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-10-13
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-10-20
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-10-27
Survey response — day 28, dose 3
MedDRA: Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities

Free text: Totally unrelated to covid.

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Survey response — day 35, dose 3
MedDRA: Cough, Diarrhoea, Malaise, Oropharyngeal pain, Pain, Parosmia, Productive cough, Secretion discharge — Feeling: Poor · Be unable to do your normal daily activities

Free text: Sore throat, body aches, change in sense of smell, general malaise, diarrhea, excessive mucus and phlegm, mild cough. I think I caught something at a Halloween party. We all wore masks except when eating. Heart rate fine oxygen fine temperature ok.

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Survey response — day 42, dose 3
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Be unable to work or attend school, 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: I've had and have had and do have multiple health conditions for decades, too many to list here. Yes, they're been progressively worse, especially the last couple or years. I'm currently experiencing something that is going around.

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Report sent to call center — day 42, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-16
Call 1 — Left Voicemail
2021-12-29
Survey response — 3 months, dose 3
MedDRA: Adverse reaction, Loss of personal independence in daily activities, Medical counselling, Office visit, Pain, Pain management, Pre-existing disease — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: I'm sore from trying to shovel snow. I have multiple health conditions too many to list here and they affect my functioning daily and hourly. I am disabled for 20 years because of my health conditions and I have more now conditions. · Healthcare visit (other): Pain management clinic and telephone with mental health nurse

MedDRA releases: 2024-11 · check-in free text available
2021-12-29
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-30
Call 1 — Left Voicemail
2022-01-03
Callback requested for
2022-01-03
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-01	Pfizer-BioNTech
2	2021-03-22	Pfizer-BioNTech
3	2021-09-29	Pfizer-BioNTech	Flu

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 9 — 6 months, dose 2

2021-09-20

Symptoms: I'm disabled. I also had a stomach surgery, due to a large paraesophageal hiatal hernia, which was causing major problems, I have lost a lot of weight. None of it was/is related to Covid-10, in my view. I have never tested positive for Covid-19.

Healthcare visit (other): For mental health I am disabled over 20 years. I seenurse a mental health on telephone bi monthly. I see a mental health medicaiton provider several times a year, i see a therpaist many times a yr. I see my pcp a few times a year. I have seen Gastro cut off by CDC

Release 10 — day 28, dose 3

2021-10-27

Symptoms: Totally unrelated to covid.

Release 10 — day 35, dose 3

2021-11-03

Symptoms: Sore throat, body aches, change in sense of smell, general malaise, diarrhea, excessive mucus and phlegm, mild cough. I think I caught something at a Halloween party. We all wore masks except when eating. Heart rate fine oxygen fine temperature ok. cut off by CDC

Release 10 — day 42, dose 3

2021-11-11

Symptoms: I've had and have had and do have multiple health conditions for decades, too many to list here. Yes, they're been progressively worse, especially the last couple or years. I'm currently experiencing something that is going around.

Release 10 — 3 months, dose 3

2021-12-29

Symptoms: I'm sore from trying to shovel snow. I have multiple health conditions too many to list here and they affect my functioning daily and hourly. I am disabled for 20 years because of my health conditions and I have more now conditions.

Healthcare visit (other): Pain management clinic and telephone with mental health nurse

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	Medical counselling	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Pain management	·	·	✓
HCVO	Pre-existing disease	·	·	✓
SD	Adverse reaction	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Cough	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Gastric operation	·	·	✓
SD	Hiatus hernia	·	·	✓
SD	Loss of personal independence in daily activities	·	·	✓
SD	Malaise	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Parosmia	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Productive cough	·	·	✓
SD	Secretion discharge	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Weight decreased	·	·	✓

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