Y29-90221-67718

3 vaccinations 11 coded responses 26 check-ins 11 free-text entries 3 call cases

Sex: Female
Age at first dose: 21-25
ZIP prefix: 537 / WI
Registered: 2021-03-26

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

Timeline

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

2021-03-26
Registered in v-safe
2021-03-26
Dose 1 — Pfizer-BioNTech
2021-03-26
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-03-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-03-28
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-02
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-09
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-16
Dose 2 — Pfizer-BioNTech
2021-04-16
Health check-in — day 0, dose 2
Feeling: Poor · Site: Pain, Swelling · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-04-17
Survey response — days 1–6 daily, dose 2
MedDRA: Gait disturbance, Tremor — Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Worse functional gait and functional tremors

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-04-20
Survey response — days 1–6 daily, dose 2
MedDRA: Condition aggravated, Gait disturbance, Pre-existing disease, Tremor — Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Worse functional gait and functional tremors

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Survey response — days 1–6 daily, dose 2
MedDRA: Gait disturbance, Tremor — Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Worse functional gait and tremors

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-04-23
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-04-30
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-14
Survey response — day 28, dose 2
MedDRA: Condition aggravated, Gait disturbance, Pre-existing disease, Tinnitus, Tremor, Visual impairment — Feeling: Fair

Free text: Worse Functional Neurological Disorder (functional gait, functional tremors, functional vision issues, ringing ears)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Survey response — day 35, dose 2
MedDRA: Tinnitus, Tremor — Feeling: Fair

Free text: Continued worse functional gait and tremors (covid gave me functional neurological disorder), ringing ears

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-28
Survey response — day 42, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair

Free text: Continued worse Functional Neurological Disorder (gait and tremors) which was triggered by covid-19 infection in early 2020 and worsened after Pfizer dose #2, nausea, ringing ears/fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-16
Survey response — 3 months, dose 2
MedDRA: Pre-existing disease, Tympanic membrane disorder — Feeling: Good

Free text: Occasional eardrum tremoring when fatigued, similar to my functional tremors. Likely related to my Functional Neurological Disorder, which was triggered by covid-19 infection in 2020 and changed after covid vaccination.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-15
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Joint pain in hips, knees, elbows · Healthcare visit (other): on a wait list for rheumatology visit

MedDRA releases: 2024-11 · check-in free text available
2021-10-15
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)
2021-10-25
Call 1 — Left Voicemail
2021-10-25
Call successful
Not applicable - Accidental Reporting
2021-12-02
Dose 3 — Pfizer-BioNTech
2022-04-16
Survey response — 12 months, dose 2
MedDRA: Arthralgia, Connective tissue disorder, Myoclonus — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Chronic joint pain, generalized hypermobile spectrum disorder, middle ear myoclonus.

MedDRA releases: 2024-11 · check-in free text available
2022-04-16
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-19
Call 1 — Left Voicemail
2022-06-04
Survey response — 6 months, dose 3
MedDRA: Diarrhoea, Hypermobility syndrome, Irritable bowel syndrome, Myoclonus, Tinnitus — Feeling: Good

Free text: Irritable bowel syndrome with diarrhea, middle ear myoclonus, tinnitus, generalized hypermobility spectrum disorder

MedDRA releases: 2024-11 · check-in free text available
2022-12-04
Survey response — 12 months, dose 3
MedDRA: Irritable bowel syndrome — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: IBS-D

MedDRA releases: 2024-11 · check-in free text available
2022-12-04
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-12-05
Call 2 — Left Voicemail
2022-12-05
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-26	Pfizer-BioNTech
2	2021-04-16	Pfizer-BioNTech
3	2021-12-02	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-10-15	Successful 2021-10-25	Not applicable - Accidental Reporting
2022-04-16	Unsuccessful
2022-12-04	Unsuccessful

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-17

Systemic reaction (other): Worse functional gait and functional tremors

2021-04-20

Systemic reaction (other): Worse functional gait and functional tremors

2021-04-21

Systemic reaction (other): Worse functional gait and tremors

Release 8 — day 28, dose 2

2021-05-14

Symptoms: Worse Functional Neurological Disorder (functional gait, functional tremors, functional vision issues, ringing ears)

Release 8 — day 35, dose 2

2021-05-21

Symptoms: Continued worse functional gait and tremors (covid gave me functional neurological disorder), ringing ears

Release 8 — day 42, dose 2

2021-05-28

Symptoms: Continued worse Functional Neurological Disorder (gait and tremors) which was triggered by covid-19 infection in early 2020 and worsened after Pfizer dose #2, nausea, ringing ears/fatigue

Release 9 — 3 months, dose 2

2021-07-16

Symptoms: Occasional eardrum tremoring when fatigued, similar to my functional tremors. Likely related to my Functional Neurological Disorder, which was triggered by covid-19 infection in 2020 and changed after covid vaccination.

Release 10 — 6 months, dose 2

2021-10-15

Symptoms: Joint pain in hips, knees, elbows

Healthcare visit (other): on a wait list for rheumatology visit

Release 11 — 12 months, dose 2

2022-04-16

Symptoms: Chronic joint pain, generalized hypermobile spectrum disorder, middle ear myoclonus.

Release 11 — 6 months, dose 3

2022-06-04

Symptoms: Irritable bowel syndrome with diarrhea, middle ear myoclonus, tinnitus, generalized hypermobility spectrum disorder

Release 12 — 12 months, dose 3

2022-12-04

Symptoms: IBS-D

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	Unevaluable event	·	·	✓
SD	Arthralgia	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Connective tissue disorder	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Gait disturbance	✓	✓	✓
SD	Hypermobility syndrome	·	·	✓
SD	Irritable bowel syndrome	·	·	✓
SD	Myoclonus	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Tinnitus	✓	✓	✓
SD	Tremor	✓	✓	✓
SD	Tympanic membrane disorder	✓	·	✓
SD	Visual impairment	✓	✓	✓
SRO	Condition aggravated	·	·	✓
SRO	Gait disturbance	✓	✓	✓
SRO	Pre-existing disease	·	·	✓
SRO	Tremor	✓	✓	✓

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