XV3-38092-06821

1 vaccination 11 coded responses 15 check-ins 11 free-text entries 2 call cases

Sex: Male
Age at first dose: 51-55
ZIP prefix: 481 / MI
Registered: 2021-08-03

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

Timeline

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

2021-08-03
Registered in v-safe
2021-08-03
Dose 1 — Pfizer-BioNTech
2021-08-03
Survey response — 0 day, dose 1
MedDRA: Dizziness, Dyspnoea, Malaise, Office visit, Sinus arrhythmia — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache · Get care from a doctor or other healthcare professional

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-03
Report sent to call center — 0 day, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-04
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Eye discharge, Pulmonary congestion, Rhinorrhoea — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-05
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-08-06
Survey response — days 1–6 daily, dose 1
MedDRA: Anger, Crying, Emotional disorder, Suicidal ideation — Feeling: Poor · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-07
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling abnormal, Mood altered — Feeling: Poor · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-08
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite — Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-09
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-08-10
Survey response — 7 day, dose 1
MedDRA: Cough, Depression, Nightmare, Palpitations — Feeling: Poor · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-16
Call 1 — Left Voicemail
2021-08-17
Survey response — 14 day, dose 1
MedDRA: Constipation, Dysgeusia, Fatigue, Headache — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-08-26
Survey response — 21 day, dose 1
MedDRA: Blood pressure fluctuation, Heart rate decreased — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-09-01
Health check-in — 28 day, dose 1
Feeling: Poor

Adult check-in
2021-09-07
Health check-in — 35 day, dose 1
Feeling: Fair

Adult check-in
2021-09-14
Survey response — 42 day, dose 1
MedDRA: Fatigue, Fear, Feeling hot, Heart rate increased, Hypersomnia, Unevaluable event — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2021-11-02
Survey response — 3 month, dose 1
MedDRA: Abdominal pain upper, Blood pressure fluctuation, Dyspnoea, Emergency care, Heart rate irregular — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-02-02
Survey response — 6 month, dose 1
MedDRA: Blood pressure inadequately controlled, Cardiac disorder, Electrocardiogram abnormal, Heart rate abnormal, Heart rate irregular, Impaired work ability — Feeling: Poor · 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

MedDRA releases: 2024-11 · check-in answers available
2022-02-02
Report sent to call center — 6 month, 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

Emergency room or emergency department visit · 1 call case(s)
2022-02-03
Call 1 — Left Voicemail
2022-02-04
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-08-03	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-08-03	Successful	Participant prefers to complete VAERS report online
2022-02-02	Successful 2022-02-04	Participant prefers to complete VAERS report online

Free text

Release 9

Systemic reaction (other): Dizzy hard to breathe erratic sinus rhythm

Healthcare visit (other): My dr made me stay at their office one hour and sent me home? I feeling like Im dying

Systemic reaction (other): Coughing, runny nose and eyes lungs feel full

Systemic reaction (other): Strange emotional disturbances! Sudden crying for no reason followed by anger and thoughts of suicide

Systemic reaction (other): Strangely moody, and feel like general dog shit

Systemic reaction (other): I'll oss of appetite

Systemic reaction (other): Extreme Depression! Why? Nightmares etc. This is not right. Bad cough heart palps

Symptoms: Severe headaches constipation total fatigue everything taste funny that i eat!

Symptoms: Low blood pressure, and low heart rate then bp spikes to 248/90 out of no where

Symptoms: Cardiac, my heart starts to raise bounding high sinus rythm pulse 145 bp raises from normal to super high last a few minutes to an hour feels like im on fire inside out! Scary crazy feeling followed by extreme fatigue i slept 18 hours....

Release 10

Symptoms: Had to go to the hospital, have a irregular heartbeat I have been having stomach pain and short of breath and having trouble keeping stable blood pressure keeps spiking then dropping low

Release 11

Symptoms: Unstable BP and HR. Irregular sinus rhythm notable on all EKGs new heart condition couldnt have any more vaccinations due to reaction my health has gone to hell and i have to apply for disability because im unable to work

Free-text releases are not linked to a specific 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	Malaise	✓	·	✓
HCVO	Office visit	✓	·	✓
SD	Abdominal pain upper	·	·	✓
SD	Blood pressure fluctuation	✓	·	✓
SD	Blood pressure inadequately controlled	·	·	✓
SD	Cardiac disorder	·	·	✓
SD	Constipation	✓	·	✓
SD	Dysgeusia	✓	·	✓
SD	Dyspnoea	·	·	✓
SD	Electrocardiogram abnormal	·	·	✓
SD	Emergency care	·	·	✓
SD	Fatigue	✓	·	✓
SD	Fear	·	·	✓
SD	Feeling hot	·	·	✓
SD	Headache	✓	·	✓
SD	Heart rate abnormal	·	·	✓
SD	Heart rate decreased	✓	·	✓
SD	Heart rate increased	·	·	✓
SD	Heart rate irregular	·	·	✓
SD	Hypersomnia	·	·	✓
SD	Impaired work ability	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Anger	✓	·	✓
SRO	Cough	✓	·	✓
SRO	Crying	✓	·	✓
SRO	Decreased appetite	✓	·	✓
SRO	Depression	✓	·	✓
SRO	Dizziness	✓	·	✓
SRO	Dyspnoea	✓	·	✓
SRO	Emotional disorder	✓	·	✓
SRO	Eye discharge	✓	·	✓
SRO	Feeling abnormal	✓	·	✓
SRO	Mood altered	✓	·	✓
SRO	Nightmare	✓	·	✓
SRO	Palpitations	✓	·	✓
SRO	Pulmonary congestion	✓	·	✓
SRO	Rhinorrhoea	✓	·	✓
SRO	Sinus arrhythmia	✓	·	✓
SRO	Suicidal ideation	✓	·	✓

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