QAT-16400-56779

4 vaccinations 5 coded responses 20 check-ins 4 free-text entries 4 call cases

Sex: Female
Age at first dose: 26-30
ZIP prefix: 021 / MA
Registered: 2021-05-20

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

JYR-28183-38236 Child or adolescent in my care · Female · 2022-09-12

Timeline

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

2021-04-18
Dose 1 — Pfizer-BioNTech
2021-05-09
Dose 2 — Pfizer-BioNTech
2021-05-20
Registered in v-safe
2021-05-20
Survey response — day 7, dose 2
MedDRA: Hypersensitivity — Feeling: Fair · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Dermatologist diagnosed delayed hypersensitivity to vaccine today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Report sent to call center — day 7, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-23
Survey response — day 14, dose 2
MedDRA: Office visit, Rash, Rash pruritic — 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: Full-body itchy rash, tentative diagnosis of delayed hypersensitivity due to vaccine from dermatologist, not resolving with anti-histamines or rx topical steroid

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-30
Survey response — day 21, dose 2
MedDRA: Hypersensitivity, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic rash ongoing since may 1. Biopsy taken last week.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-30
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-08
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-15
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-08-08
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-11-07
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-18
Dose 3 — Pfizer-BioNTech
2022-04-08
Call 1 — Left Voicemail
2022-05-21
Survey response — 6 months, dose 3
MedDRA: Cough, Dehydration, Emergency care, Fatigue, Headache, Nausea, Rhinorrhoea, Throat irritation, Vomiting — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Covid symptoms - scratchy throat, fatigue, headaches, cough and runny nose, severe nausea and vomiting (resulted in ER visit due to severe dehydration)

MedDRA releases: 2024-11 · check-in free text available
2022-05-21
Report sent to call center — 6 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

Emergency room or emergency department visit · 1 call case(s)
2022-05-23
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-23
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-23
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-23
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-09-12
Dose 4 — Moderna
2022-09-12
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-09-16
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache

Adult check-in
2022-09-19
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-09-28
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-03
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-12
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-19
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-10-24
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-16
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-03-13
Survey response — 6 months, dose 4
MedDRA: Pruritus — Feeling: Good

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-18	Pfizer-BioNTech
2	2021-05-09	Pfizer-BioNTech
3	2021-11-18	Pfizer-BioNTech	No
4	2022-09-12	Moderna	No

Call center

4 call center cases

4 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 8 — day 7, dose 2

2021-05-20

Systemic reaction (other): Dermatologist diagnosed delayed hypersensitivity to vaccine today

Release 8 — day 14, dose 2

2021-05-23

Symptoms: Full-body itchy rash, tentative diagnosis of delayed hypersensitivity due to vaccine from dermatologist, not resolving with anti-histamines or rx topical steroid

Release 8 — day 21, dose 2

2021-05-30

Symptoms: Systemic rash ongoing since may 1. Biopsy taken last week.

Release 11 — 6 months, dose 3

2022-05-21

Symptoms: Covid symptoms - scratchy throat, fatigue, headaches, cough and runny nose, severe nausea and vomiting (resulted in ER visit due to severe dehydration)

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	Cough	·	·	✓
SD	Dehydration	·	·	✓
SD	Emergency care	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Hypersensitivity	✓	✓	✓
SD	Nausea	·	·	✓
SD	Office visit	✓	✓	✓
SD	Pruritus	·	·	✓
SD	Rash	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	Throat irritation	·	·	✓
SD	Vomiting	·	·	✓
SRO	Hypersensitivity	✓	✓	✓

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