XYC-69393-99444

4 vaccinations 4 coded responses 38 check-ins 4 free-text entries 3 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 490 / MI
Registered: 2020-12-18

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

2020-12-18
Registered in v-safe
2020-12-18
Dose 1 — Pfizer-BioNTech
2020-12-18
Health check-in — 0 day, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2020-12-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2020-12-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2020-12-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-25
Health check-in — 7 day, dose 1
Feeling: Good · None

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

Adult check-in
2021-01-08
Dose 2 — Pfizer-BioNTech
2021-01-09
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-11
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
2021-01-24
Health check-in — 14 day, dose 2
Feeling: Good

Adult check-in
2021-01-29
Health check-in — 21 day, dose 2
Feeling: Good

Adult check-in
2021-02-05
Health check-in — 28 day, dose 2
Feeling: Good

Adult check-in
2021-02-12
Health check-in — 35 day, dose 2
Feeling: Good

Adult check-in
2021-02-19
Survey response — 42 day, dose 2
MedDRA: Appendicectomy, Surgery — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-02-19
Report sent to call center — 42 day, 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)
2021-04-09
Survey response — 3 month, dose 2
MedDRA: Abdominal pain, Appendicitis, COVID-19, Fatigue, Oropharyngeal pain, SARS-CoV-2 test positive — Feeling: Fair · 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-09
Report sent to call center — 3 month, 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)
2021-07-09
Survey response — 6 month, dose 2
MedDRA: Fatigue, Gastrointestinal disorder, Impaired work ability, Loss of personal independence in daily activities, SARS-CoV-2 test positive — Feeling: Fair · Be unable to work or attend school, 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, Emergency room or emergency department visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-07-09
Report sent to call center — 6 month, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-14
Call 1 — Left Voicemail
2021-09-28
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2021-10-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-05
Health check-in — 7 day, dose 3
Feeling: Good · None

Adult check-in
2021-10-12
Health check-in — 14 day, dose 3
Feeling: Fair

Adult check-in
2021-10-19
Health check-in — 21 day, dose 3
Feeling: Good

Adult check-in
2021-10-27
Health check-in — 28 day, dose 3
Feeling: Fair

Adult check-in
2021-11-02
Health check-in — 35 day, dose 3
Feeling: Fair

Adult check-in
2021-11-11
Health check-in — 42 day, dose 3
Feeling: Good

Adult check-in
2021-11-13
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-28
Health check-in — 3 month, dose 3
Feeling: Good

Adult check-in
2022-03-29
Survey response — 6 month, dose 3
MedDRA: Cough, Headache, Malaise, Rhinorrhoea — Feeling: Fair

MedDRA releases: 2024-11 · check-in answers available
2022-09-29
Health check-in — 12 month, dose 3
Feeling: Good

Adult check-in
2023-02-11
Dose 4 — Pfizer-BioNTech
2023-02-12
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2023-02-13
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2023-02-14
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2023-02-15
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2023-02-16
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2023-02-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2023-02-18
Health check-in — 7 day, dose 4
Feeling: Good · None

Adult check-in
2023-03-20
Health check-in — 35 day, dose 4
Feeling: Good

Adult check-in
2023-05-14
Health check-in — 3 month, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-18	Pfizer-BioNTech
2	2021-01-08	Pfizer-BioNTech
3	2021-09-28	Pfizer-BioNTech	Flu
4	2023-02-11	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-19	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-04-09	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-07-09	Successful 2021-11-13	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 4

Symptoms: I had my appendix removed this morning, so symptoms are all related to that.

Healthcare visit (other): Surgical procedure

Release 7

Symptoms: Appendicitis, with removal of appendix on 2/19/21. Then became sick on 3/20/21 with worsening of symptoms leading to 2 ER visits. Tested positive for Covid-19 on 3/28/21. Still recovering. Sore throat, horrible abdominal pain, extreme fatigue.

Release 9

Symptoms: I ended up getting Covid and having a positive test on 3-28-21. After that, my intestinal system shut down and I spent about 2 months on significant amounts of laxatives. I am still not back at work, and am limited with my ADLs. Fatigue was an issue cut off by CDC

Release 11

Symptoms: Nasal drainage, cough, headache, malaise

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	Surgery	✓	✓	✓
SD	Abdominal pain	✓	✓	✓
SD	Appendicectomy	✓	✓	✓
SD	Appendicitis	✓	✓	✓
SD	Cough	·	·	✓
SD	COVID-19	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Headache	·	·	✓
SD	Impaired work ability	✓	✓	✓
SD	Loss of personal independence in daily activities	✓	✓	✓
SD	Malaise	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test positive	✓	✓	✓

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