W9A-19740-07483

1 vaccination 10 coded responses 13 check-ins 11 free-text entries 2 call cases

Sex: Female
Age at first dose: 26-30
ZIP prefix: 276 / NC
Registered: 2021-10-26

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-10-26
Registered in v-safe
2021-10-26
Dose 1 — Pfizer-BioNTech
2021-10-26
Survey response — day 0, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Light headedness

MedDRA releases: 2024-11 · check-in free text available
2021-10-27
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Headache, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school

Adult check-in
2021-10-28
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Poor · Site: Pain, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Short of Breath

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Poor · Site: Pain, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Dyspnoea — Feeling: Poor · Site: Pain, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Lightheaded ness/ short of breath

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Dyspnoea — Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Shortness of breath / dizziness

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Survey response — day 7, dose 1
MedDRA: Dyspnoea, Foetal hypokinesia — Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, 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: Shortness of breath , decrease in fetal movement

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Report sent to call center — day 7, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-04
Call 1 — Left Voicemail
2021-11-11
Survey response — day 14, dose 1
MedDRA: Fatigue, Nausea, Pain — Feeling: Poor · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: More nauseous, fatigue , body soreness.

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Report sent to call center — day 14, dose 1
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-12
Call 1 — Left Voicemail
2021-11-16
Survey response — day 21, dose 1
MedDRA: Abdominal pain, Fatigue, Headache, Hypoaesthesia — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Headaches ,Severe fatigue & Abdominal pain. Arm numbness .

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Health check-in — day 28, dose 1
Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Runny nose , scratchy throat , extreme fatigue

Adult check-in · check-in free text available
2021-12-07
Survey response — day 42, dose 1
MedDRA: Fatigue, Myalgia — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Severe fatigue , tiredness, server muscle soreness

MedDRA releases: 2024-11 · check-in free text available
2022-04-28
Health check-in — 6 months, dose 1
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-10-26	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-11-02	Unsuccessful
2021-11-11	Unsuccessful

Free text

Release 10 — day 0, dose 1

2021-10-26

Systemic reaction (other): Light headedness

Release 10 — days 1–6 daily, dose 1

2021-10-28

Systemic reaction (other): Short of Breath

2021-10-29

Systemic reaction (other): Shortness of breath

2021-10-30

Systemic reaction (other): Lightheaded ness/ short of breath

2021-10-31

Systemic reaction (other): Shortness of breath

2021-11-01

Systemic reaction (other): Shortness of breath / dizziness

Release 10 — day 7, dose 1

2021-11-02

Systemic reaction (other): Shortness of breath , decrease in fetal movement

Release 10 — day 14, dose 1

2021-11-11

Symptoms: More nauseous, fatigue , body soreness.

Release 10 — day 21, dose 1

2021-11-16

Symptoms: Headaches ,Severe fatigue & Abdominal pain. Arm numbness .

Release 10 — day 42, dose 1

2021-12-07

Symptoms: Severe fatigue , tiredness, server muscle soreness

Release 12 — day 28, dose 1

2021-11-28

Symptoms: Runny nose , scratchy throat , extreme fatigue

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	Abdominal pain	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Myalgia	·	·	✓
SD	Nausea	·	·	✓
SD	Pain	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Foetal hypokinesia	·	·	✓

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