69S-49591-75351
4 vaccinations
4 coded responses
32 check-ins
4 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 631 / MO
- Registered
- 2021-02-02
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-01
Dose 1 — Pfizer-BioNTech
-
2021-02-02
Registered in v-safe
- 2021-02-02
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-08
- 2021-02-15
-
2021-02-22
Dose 2 — Pfizer-BioNTech
- 2021-02-23
- 2021-02-24
- 2021-02-25
-
2021-02-26
Survey response — days 1–6 daily, dose 2MedDRA: Confusional state, Distractibility — Feeling: GoodFree text: After both shots I noticed more distraction than usual. I missed zoom calls and had some confusion.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-08
- 2021-03-15
- 2021-03-22
- 2021-03-29
- 2021-04-05
- 2021-05-26
-
2021-08-23
Survey response — 6 months, dose 2MedDRA: Blood iron decreased, Faeces discoloured, Haemoglobin decreased, Internal haemorrhage, Pulmonary embolism — Feeling: Fair · 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 visitFree text: Black stools. Low hemoglobin (8) low iron (20) went off blood thinner for two months. Then had blood clots in both lungs. Had upper, lower and middle endoscopies. Unable to determine cause of internal bleeding. Hemoglobin and iron now back in normalMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-23
Report sent to call center — 6 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-08-24
Dose 3 — Pfizer-BioNTech
-
2021-08-30
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-09-30
- 2021-10-05
- 2021-11-23
-
2022-02-24
Survey response — 6 months, dose 3MedDRA: Vertigo — Feeling: Good · Be unable to do your normal daily activitiesFree text: VertigoMedDRA releases: 2024-11 · check-in free text available
-
2022-04-28
Dose 4 — Moderna
- 2022-05-14
- 2022-05-19
- 2022-05-26
- 2022-06-02
- 2022-06-11
- 2022-07-28
-
2022-10-29
Survey response — 6 months, dose 4MedDRA: Fatigue, Headache, Pain, Quarantine, Rhinorrhoea, SARS-CoV-2 test positive, Throat irritation — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Scratching throat, runny nose, headache, aches and pains, fatigue. Due to positive Covid test. I stayed quarantined the appropriate time.MedDRA releases: 2024-11 · check-in free text available
-
2022-10-29
Report sent to call center — 6 months, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-10-31
Call successfulParticipant prefers to complete VAERS report online
- 2023-04-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-01 | Pfizer-BioNTech | |
| 2 | 2021-02-22 | Pfizer-BioNTech | |
| 3 | 2021-08-24 | Pfizer-BioNTech | No |
| 4 | 2022-04-28 | Moderna | No |
Call center
2 call center cases
2 successful
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): After both shots I noticed more distraction than usual. I missed zoom calls and had some confusion.
Release 9 — 6 months, dose 2
Symptoms: Black stools. Low hemoglobin (8) low iron (20) went off blood thinner for two months. Then had blood clots in both lungs. Had upper, lower and middle endoscopies. Unable to determine cause of internal bleeding. Hemoglobin and iron now back in normal cut off by CDC
Release 11 — 6 months, dose 3
Symptoms: Vertigo
Release 12 — 6 months, dose 4
Symptoms: Scratching throat, runny nose, headache, aches and pains, fatigue. Due to positive Covid test. I stayed quarantined the appropriate time.
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 | Blood iron decreased | ✓ | · | ✓ |
| SD | Faeces discoloured | ✓ | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Haemoglobin decreased | ✓ | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Internal haemorrhage | ✓ | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pulmonary embolism | ✓ | · | ✓ |
| SD | Quarantine | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Throat irritation | · | · | ✓ |
| SD | Vertigo | · | · | ✓ |
| SRO | Confusional state | ✓ | ✓ | ✓ |
| SRO | Distractibility | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release