KVL-11770-52465

4 vaccinations 16 coded responses 47 check-ins 16 free-text entries 7 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 160 / PA
Registered: 2021-02-13

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

2021-02-12
Dose 1 — Pfizer-BioNTech
2021-02-13
Registered in v-safe
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-17
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Respiratory tract congestion — Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: congestion, very bad unusual headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-19
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-26
Health check-in — day 14, dose 1
Feeling: Poor

Adult check-in
2021-03-05
Dose 2 — Pfizer-BioNTech
2021-03-05
Health check-in — day 0, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Myalgia — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: deep ache in muscle in injection arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Have fibromyalgia & arthritis, so I don't really think vaccine is causing any further issue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-14
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-19
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-26
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-02
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-09
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-16
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-04
Survey response — 3 months, dose 2
MedDRA: Bladder irritation, Epigastric discomfort — Feeling: Poor · 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: increased gastric and bladder irritation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-03
Survey response — 6 months, dose 2
MedDRA: Dyspnoea, Neuralgia, Office visit, Pain, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Shooting nerve pain in leg and foot, shortness of breath · Healthcare visit (other): in office appts

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-03
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-07
Call successful
Not applicable - Accidental Reporting
2021-09-07
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-24
Dose 3 — Pfizer-BioNTech
2021-10-02
Health check-in — day 7, dose 3
Feeling: Fair · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-08
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-10-15
Survey response — day 21, dose 3
MedDRA: Headache, Nausea, Pain in extremity — Feeling: Fair

Free text: nausea, headache, sorer arm

MedDRA releases: 2024-11 · check-in free text available
2021-10-22
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-10-29
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-11-05
Survey response — day 42, dose 3
MedDRA: Extremity necrosis, Sciatica, Spinal pain, Tendonitis — 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: necrosis in forefoot, posterior tibial tendinitis, spinal/sciatica pain

MedDRA releases: 2024-11 · check-in free text available
2021-11-05
Report sent to call center — day 42, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-08
Call 1 — Left Voicemail
2021-12-24
Survey response — 3 months, dose 3
MedDRA: Extremity necrosis, Osteochondrosis, Tendonitis — 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: Freiberg's Disease - necrosis in foot, posterior tibial tendonitis

MedDRA releases: 2024-11 · check-in free text available
2021-12-24
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-27
Call successful
Participant prefers to complete VAERS report online
2022-03-25
Survey response — 6 months, dose 3
MedDRA: Basal cell carcinoma, Osteochondrosis, Tendonitis — 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

Free text: basal cell carcinoma, freiberg's disease right foot, tendonitis in both legs

MedDRA releases: 2024-11 · check-in free text available
2022-03-25
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-03-28
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-06-15
Dose 4 — Pfizer-BioNTech
2022-06-15
Health check-in — day 0, dose 4
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2022-06-16
Survey response — days 1–6 daily, dose 4
MedDRA: Injection site pain, Pre-existing disease — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: have fibro & arthritis, so only mild pain at injection site seems related to vax & possibly headache

MedDRA releases: 2024-11 · check-in free text available
2022-06-17
Survey response — days 1–6 daily, dose 4
MedDRA: Pain in extremity, Pre-existing disease — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: only mildly sore arm from vax, rest grom chronic vonditions

MedDRA releases: 2024-11 · check-in free text available
2022-06-18
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-06-19
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-06-20
Survey response — days 1–6 daily, dose 4
MedDRA: Pre-existing disease — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Free text: normal chronic issues ... I don't think related to vax

MedDRA releases: 2024-11 · check-in free text available
2022-06-21
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-06-22
Health check-in — day 7, dose 4
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-06-30
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-07-06
Survey response — day 21, dose 4
MedDRA: Diarrhoea — Feeling: Fair

Free text: diarrhea

MedDRA releases: 2024-11 · check-in free text available
2022-07-13
Survey response — day 28, dose 4
MedDRA: Lactose intolerance — Feeling: Fair

Free text: lactose intolerance

MedDRA releases: 2024-11 · check-in free text available
2022-07-20
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-07-29
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-09-16
Survey response — 3 months, dose 4
MedDRA: Abdominal pain, COVID-19, Cough, Diarrhoea, Fatigue, Headache, Muscle spasms, Nausea, Office visit, Oropharyngeal pain, Productive cough, Respiratory tract congestion, Rhinorrhoea, Vaginal haemorrhage — Feeling: Poor · 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: Symptoms: got covid with sore throat, nose blowing, congestion, headache, phlegm, coughing, fatigue, nausea, diarrhea, abdominal pain, vaginal bleeding and cramping. · Healthcare visit (other): in-person post-infection dr check, pelvic ultrasound, and gastro dr appy

MedDRA releases: 2024-11 · check-in free text available
2022-09-16
Report sent to call center — 3 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-12-14
Survey response — 6 months, dose 4
MedDRA: Abdominal pain, Alopecia, Biopsy uterus abnormal, COVID-19, Cervical polyp, Endometrial thickening, Nodule, Postmenopausal haemorrhage, Ultrasound scan abnormal, Unevaluable event — 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 visit

Free text: Symptoms: Extensive hair loss, lower abdominal cramping since post-menopausal uterine bleeding along with covid in August, ultrasound&biopsy show thickened endometrium with cervical polyp and unknown nodule. Scheduled for hysteroscopy and D&C on Dec 16 2022. · Healthcare visit (other): testing, upcoming surgery in hospital

MedDRA releases: 2024-11 · check-in free text available
2022-12-14
Report sent to call center — 6 months, dose 4
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 · 1 call case(s)
2022-12-15
Call 1 — Left Voicemail
2022-12-15
Call successful
Completed over the phone
2022-12-15
Call successful
Completed over the phone
2023-06-17
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-12	Pfizer-BioNTech
2	2021-03-05	Pfizer-BioNTech
3	2021-09-24	Pfizer-BioNTech	No
4	2022-06-15	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-06-04	Successful 2021-09-07	Not applicable - Accidental Reporting
2021-09-03	Successful 2021-09-07	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-05	Successful	Participant prefers to complete VAERS report online
2021-12-24	Successful 2021-12-27	Participant prefers to complete VAERS report online
2022-03-25	Successful 2022-03-28	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-09-16	Successful 2022-12-15	Completed over the phone
2022-12-14	Successful 2022-12-15	Completed over the phone

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-17

Systemic reaction (other): congestion, very bad unusual headache

Release 5 — days 1–6 daily, dose 2

2021-03-06

Systemic reaction (other): deep ache in muscle in injection arm

2021-03-08

Systemic reaction (other): Have fibromyalgia & arthritis, so I don't really think vaccine is causing any further issue.

Release 8 — 3 months, dose 2

2021-06-04

Symptoms: increased gastric and bladder irritation

Release 9 — 6 months, dose 2

2021-09-03

Symptoms: Shooting nerve pain in leg and foot, shortness of breath

Healthcare visit (other): in office appts

Release 10 — day 21, dose 3

2021-10-15

Symptoms: nausea, headache, sorer arm

Release 10 — day 42, dose 3

2021-11-05

Symptoms: necrosis in forefoot, posterior tibial tendinitis, spinal/sciatica pain

Release 10 — 3 months, dose 3

2021-12-24

Symptoms: Freiberg's Disease - necrosis in foot, posterior tibial tendonitis

Release 11 — 6 months, dose 3

2022-03-25

Symptoms: basal cell carcinoma, freiberg's disease right foot, tendonitis in both legs

Release 12 — days 1–6 daily, dose 4

2022-06-16

Systemic reaction (other): have fibro & arthritis, so only mild pain at injection site seems related to vax & possibly headache

2022-06-17

Systemic reaction (other): only mildly sore arm from vax, rest grom chronic vonditions

2022-06-20

Systemic reaction (other): normal chronic issues ... I don't think related to vax

Release 12 — day 21, dose 4

2022-07-06

Symptoms: diarrhea

Release 12 — day 28, dose 4

2022-07-13

Symptoms: lactose intolerance

Release 12 — 3 months, dose 4

2022-09-16

Symptoms: got covid with sore throat, nose blowing, congestion, headache, phlegm, coughing, fatigue, nausea, diarrhea, abdominal pain, vaginal bleeding and cramping.

Healthcare visit (other): in-person post-infection dr check, pelvic ultrasound, and gastro dr appy

Release 12 — 6 months, dose 4

2022-12-14

Symptoms: Extensive hair loss, lower abdominal cramping since post-menopausal uterine bleeding along with covid in August, ultrasound&biopsy show thickened endometrium with cervical polyp and unknown nodule. Scheduled for hysteroscopy and D&C on Dec 16 2022. cut off by CDC

Healthcare visit (other): testing, upcoming surgery in hospital

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	✓	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Abdominal pain	·	·	✓
SD	Alopecia	·	·	✓
SD	Basal cell carcinoma	·	·	✓
SD	Biopsy uterus abnormal	·	·	✓
SD	Bladder irritation	✓	✓	✓
SD	Cervical polyp	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Dyspnoea	✓	·	✓
SD	Endometrial thickening	·	·	✓
SD	Epigastric discomfort	✓	✓	✓
SD	Extremity necrosis	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Lactose intolerance	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Nausea	·	·	✓
SD	Neuralgia	✓	·	✓
SD	Nodule	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Osteochondrosis	·	·	✓
SD	Pain	✓	·	✓
SD	Pain in extremity	✓	·	✓
SD	Postmenopausal haemorrhage	·	·	✓
SD	Productive cough	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Sciatica	·	·	✓
SD	Spinal pain	·	·	✓
SD	Tendonitis	·	·	✓
SD	Ultrasound scan abnormal	·	·	✓
SD	Vaginal haemorrhage	·	·	✓
SRO	Headache	✓	✓	✓
SRO	Injection site pain	·	·	✓
SRO	Myalgia	✓	✓	✓
SRO	Pain in extremity	·	·	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓

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