Y3V-13409-23801

3 vaccinations 10 coded responses 25 check-ins 10 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 936 / CA
Registered: 2021-03-04

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

Timeline

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

2021-03-04
Registered in v-safe
2021-03-04
Dose 1 — Pfizer-BioNTech
2021-03-04
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-05
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal discomfort, Feeling hot — Feeling: Fair · Site: Pain

Free text: Got very hot and felt a little sick at stomach for 45 min

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-03-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-01
Dose 2 — Pfizer-BioNTech
2021-04-01
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Back pain not sure if its from vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Diarrhea, Abdominal pain

Free text: This happened on Sat not today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Pain · Muscle or body aches · Be unable to do your normal daily activities

Free text: Just Back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities

Free text: Low back pain not sure if from vaccination

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Good · Muscle or body aches

Free text: Lower back still hurts some not sure if its from vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Survey response — day 7, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Pain · Muscle or body aches

Free text: Still low Back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-13
Survey response — day 42, dose 2
MedDRA: Dizziness, Feeling hot, Malaise, Nausea, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Got sick yesterday. Felt dizzy and sick at my stomach. I vomited last night. Not sure what caused it except maybe I got overheated

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-14
Dose 3 — Pfizer-BioNTech
Co-administered: Shingles
2021-07-01
Survey response — 3 months, dose 2
MedDRA: Injection site pain, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Some arm at times from site where I got COVID vaccine. Not all the time. I have had to see a pulmonologist recently Not sure why yet. They are taking X-rays etc. · Healthcare visit (other): Pulmonologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-01
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-06
Call successful
Participant prefers to complete VAERS report online
2021-09-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-06-14
Survey response — 12 months, dose 3
MedDRA: Injection site pain, Office visit, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Just sore arm where I had received vaccine. It comes and goes. Not too bad. I have asthma and Dr testing for bladder or kidney problem but no results yet. May not be related to vaccines just stating differences in my health. · Healthcare visit (other): Primary doctor

MedDRA releases: 2024-11 · check-in free text available
2022-06-14
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-06-15
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-04	Pfizer-BioNTech
2	2021-04-01	Pfizer-BioNTech
3	2021-06-14	Pfizer-BioNTech	Shingles

Call center

Reported	Outcome	VAERS-related outcome
2021-07-01	Successful 2021-07-06	Participant prefers to complete VAERS report online
2022-06-14	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-05

Systemic reaction (other): Got very hot and felt a little sick at stomach for 45 min

Release 6 — days 1–6 daily, dose 2

2021-04-02

Systemic reaction (other): Back pain not sure if its from vaccine

2021-04-04

Systemic reaction (other): This happened on Sat not today

2021-04-05

Systemic reaction (other): Just Back pain

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): Low back pain not sure if from vaccination

2021-04-07

Systemic reaction (other): Lower back still hurts some not sure if its from vaccine

Release 7 — day 7, dose 2

2021-04-08

Systemic reaction (other): Still low Back pain

Release 8 — day 42, dose 2

2021-05-13

Symptoms: Got sick yesterday. Felt dizzy and sick at my stomach. I vomited last night. Not sure what caused it except maybe I got overheated

Release 9 — 3 months, dose 2

2021-07-01

Symptoms: Some arm at times from site where I got COVID vaccine. Not all the time. I have had to see a pulmonologist recently Not sure why yet. They are taking X-rays etc.

Healthcare visit (other): Pulmonologist

Release 12 — 12 months, dose 3

2022-06-14

Symptoms: Just sore arm where I had received vaccine. It comes and goes. Not too bad. I have asthma and Dr testing for bladder or kidney problem but no results yet. May not be related to vaccines just stating differences in my health.

Healthcare visit (other): Primary doctor

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	Office visit	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Feeling hot	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Malaise	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Office visit	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Vomiting	✓	✓	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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