84Z-10389-87853

3 vaccinations 6 coded responses 37 check-ins 6 free-text entries 4 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 701 / LA
Registered: 2021-01-16

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

2021-01-16
Registered in v-safe
2021-01-16
Dose 1 — Pfizer-BioNTech
2021-01-16
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness, Swelling · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-31
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-06
Dose 2 — Pfizer-BioNTech
2021-02-06
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Diarrhea, Abdominal pain

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-11
Survey response — days 1–6 daily, dose 2
MedDRA: Blepharitis, Immunisation reaction, Lip swelling, Mouth swelling, Office visit — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): I'm having an allergic inflammatory response involving my eyelids, hard palate, lips, and skin around my mouth. Unknown allergen. · Healthcare visit (other): I saw a doctor this a.m. who instructed me to go to the site where i was vaccinated. Based on my symptoms, they wanted me to be observed at the ER but i went home instead and used benadryl and cold compresses.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-12
Survey response — days 1–6 daily, dose 2
MedDRA: Blepharitis, Lip pruritus, Oral pruritus, Rash, Rash erythematous, Rash pruritic, Vision blurred — Feeling: Poor · Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Inflammation of eyelids, blurry vision in r eye, itchy scratchy red dry rash on skin around mouth, itchy lips and hard palate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-13
Survey response — day 7, dose 2
MedDRA: Oral mucosal erythema, Oral pruritus, Swelling of eyelid, Vision blurred — Feeling: Poor · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Swollen eyelids, r eyesight blurring, itchiness and redness in and around mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-06
Survey response — day 28, dose 2
MedDRA: Erythema, Pruritus, Swelling of eyelid — Feeling: Good · Be unable to do your normal daily activities

Free text: Itchy, red face, swollen eyelids

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-20
Survey response — day 42, dose 2
MedDRA: Periorbital swelling, Pruritus — Feeling: Fair · 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: Recurrence of mild eye and lips puffiness and itchiness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-08
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-07
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-08-09
Call 2 — Left Voicemail
2021-12-10
Dose 3 — Moderna
2021-12-10
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-12-11
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Diarrhea

Adult check-in
2021-12-12
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-14
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-15
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-16
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-17
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-24
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-31
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-07
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-14
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-21
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-11
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-10
Survey response — 6 months, dose 3
MedDRA: Localised infection, Pseudomonas infection, SARS-CoV-2 test positive — Feeling: Good · Be unable to work or attend school, 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: I tested covid + by home test and rapid pcr, i had no symptoms. At the same time I had a pseudomonas infection on my r foot.

MedDRA releases: 2024-11 · check-in free text available
2022-06-10
Report sent to call center — 6 months, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-13
Call 1 — Left Voicemail
2022-06-13
Call 1 — Left Voicemail
2022-06-13
Call 1 — Left Voicemail
2022-06-13
Call 1 — Left Voicemail
2022-12-12
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-16	Pfizer-BioNTech
2	2021-02-06	Pfizer-BioNTech
3	2021-12-10	Moderna	No

Call center

4 call center cases

4 unsuccessful

3 waits over 3 months for a first call

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-11

Systemic reaction (other): I'm having an allergic inflammatory response involving my eyelids, hard palate, lips, and skin around my mouth. Unknown allergen.

Healthcare visit (other): I saw a doctor this a.m. who instructed me to go to the site where i was vaccinated. Based on my symptoms, they wanted me to be observed at the ER but i went home instead and used benadryl and cold compresses.

2021-02-12

Systemic reaction (other): Inflammation of eyelids, blurry vision in r eye, itchy scratchy red dry rash on skin around mouth, itchy lips and hard palate

Release 4 — day 7, dose 2

2021-02-13

Systemic reaction (other): Swollen eyelids, r eyesight blurring, itchiness and redness in and around mouth

Release 5 — day 28, dose 2

2021-03-06

Symptoms: Itchy, red face, swollen eyelids

Release 6 — day 42, dose 2

2021-03-20

Symptoms: Recurrence of mild eye and lips puffiness and itchiness.

Release 12 — 6 months, dose 3

2022-06-10

Symptoms: I tested covid + by home test and rapid pcr, i had no symptoms. At the same time I had a pseudomonas infection on my r foot.

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	Erythema	✓	✓	✓
SD	Localised infection	·	·	✓
SD	Periorbital swelling	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Pseudomonas infection	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Swelling of eyelid	✓	✓	✓
SRO	Blepharitis	✓	✓	✓
SRO	Immunisation reaction	✓	✓	✓
SRO	Lip pruritus	✓	✓	✓
SRO	Lip swelling	✓	✓	✓
SRO	Mouth swelling	✓	✓	✓
SRO	Oral mucosal erythema	✓	✓	✓
SRO	Oral pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Rash erythematous	✓	✓	✓
SRO	Rash pruritic	✓	✓	✓
SRO	Swelling of eyelid	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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