6PL-11760-84546

4 vaccinations 8 coded responses 16 check-ins 7 free-text entries 4 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 907 / CA
Registered: 2021-03-28

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

2021-03-06
Dose 1 — Pfizer-BioNTech
2021-03-25
Dose 2 — Pfizer-BioNTech
2021-03-28
Registered in v-safe
2021-03-28
Survey response — days 1–6 daily, dose 2
MedDRA: Oral herpes, Pyrexia — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Fever blister on lip, igot shot 2 days ago, fever abt. 102.8 for 2 days. Now 1000

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Survey response — days 1–6 daily, dose 2
MedDRA: Oral herpes, Oropharyngeal pain — Feeling: Fair · Fever · Headache, Fatigue or tiredness

Free text: Fever blister and slight sore throat. Symptoms were severe first 2.5 days. High fever. Better now

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — days 1–6 daily, dose 2
MedDRA: Malaise, Oral herpes — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Fever blister, still feel lousy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — day 7, dose 2
MedDRA: Oral herpes — Feeling: Good · Fatigue or tiredness

Free text: Fever blister still healing, got it 2 days after injection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-29
Survey response — day 35, dose 2
MedDRA: Alopecia — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Massive hair loss over last several weeks

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-06
Survey response — day 42, dose 2
MedDRA: Alopecia, Fatigue — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Continued massive hairloss. Still have some fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-24
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-23
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-27
Dose 3 — Pfizer-BioNTech
2022-03-27
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-04-13
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-13
Call successful
Not applicable - Accidental Reporting
2022-09-16
Dose 4 — Moderna
2022-10-07
Survey response — day 21, dose 4
MedDRA: Pre-existing disease, Thrombosis — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: The day after my most recent booster, i developed a blood clot in my left leg. Due to family history, iam now on anticoagulants. I dont know if it's related to the booster. I do have blood disorder but never had a clot.

MedDRA releases: 2024-11 · check-in free text available
2022-10-07
Report sent to call center — day 21, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-14
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-21
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2023-03-17
Survey response — 6 months, dose 4
MedDRA: Aphasia, Brain fog, Dysphonia, Thrombosis — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-03-17
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-03-20
Call 1 — Requested Callback
2023-03-20
Callback requested for
5:00PM
2023-03-20
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-06	Pfizer-BioNTech
2	2021-03-25	Pfizer-BioNTech
3	2021-12-27	Pfizer-BioNTech	No
4	2022-09-16	Moderna	No

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-28

Systemic reaction (other): Fever blister on lip, igot shot 2 days ago, fever abt. 102.8 for 2 days. Now 1000

2021-03-29

Systemic reaction (other): Fever blister and slight sore throat. Symptoms were severe first 2.5 days. High fever. Better now

2021-03-31

Systemic reaction (other): Fever blister, still feel lousy

Release 6 — day 7, dose 2

2021-04-03

Systemic reaction (other): Fever blister still healing, got it 2 days after injection

Release 8 — day 35, dose 2

2021-04-29

Symptoms: Massive hair loss over last several weeks

Release 8 — day 42, dose 2

2021-05-06

Symptoms: Continued massive hairloss. Still have some fatigue.

Release 12 — day 21, dose 4

2022-10-07

Symptoms: The day after my most recent booster, i developed a blood clot in my left leg. Due to family history, iam now on anticoagulants. I dont know if it's related to the booster. I do have blood disorder but never had a clot.

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	Alopecia	✓	✓	✓
SD	Aphasia	·	·	✓
SD	Brain fog	·	·	✓
SD	Dysphonia	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Thrombosis	·	·	✓
SRO	Malaise	✓	✓	✓
SRO	Oral herpes	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pyrexia	✓	✓	✓

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