Y4L-26568-15863

2 vaccinations 6 coded responses 21 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 481 / MI
Registered: 2021-01-17

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

2021-01-15
Dose 1 — Pfizer-BioNTech
2021-01-17
Registered in v-safe
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-05
Dose 2 — Pfizer-BioNTech
2021-02-05
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Cerebrovascular accident, Pre-existing disease, Seizure — Feeling: Poor · Chills · Be unable to do your normal daily activities

Free text: (b)(6) suffers from frontal temporal dementia. She had 2 seizures this morning. They may be strokes or epileptic type seizures shes had before. Not sure if they are related to the vaccine. She has suffered with this condition for 12-13 years.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: Seizure — Feeling: Poor · Muscle or body aches, Diarrhea · Be unable to do your normal daily activities

Free text: Seizures seem to have ceased.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains · Be unable to do your normal daily activities

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-12
Health check-in — day 7, dose 2
Feeling: Fair · Fever · Chills, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-19
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-02-26
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-07
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-14
Survey response — day 35, dose 2
MedDRA: Unevaluable event — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Symptoms: Probably end stage frontal temporal dementia. · Healthcare visit (other): Hospice

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-19
Survey response — day 42, dose 2
MedDRA: Death — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Joyce passed away March 14, 2021.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Survey response — 3 months, dose 2
MedDRA: Death, Unevaluable event — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Joyce passed 03/14/2021 · Healthcare visit (other): Trip to funeral home.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Report sent to call center — 3 months, 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)
2021-08-08
Health check-in — 6 months, dose 2
Feeling: Poor

Adult check-in
2021-12-10
Call 1 — Left Voicemail
2022-02-05
Survey response — 12 months, dose 2
MedDRA: Death — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Joyce died!

MedDRA releases: 2024-11 · check-in free text available
2022-02-05
Report sent to call center — 12 months, 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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-02-07
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Pfizer-BioNTech
2	2021-02-05	Pfizer-BioNTech

Call center

Reported	Outcome	VAERS-related outcome
2021-03-14	Unsuccessful
2021-05-07	Unsuccessful
2022-02-05	Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 2

2021-02-07

Systemic reaction (other): (b)(6) suffers from frontal temporal dementia. She had 2 seizures this morning. They may be strokes or epileptic type seizures shes had before. Not sure if they are related to the vaccine. She has suffered with this condition for 12-13 years.

redacted (b)(6)

2021-02-08

Systemic reaction (other): Seizures seem to have ceased.

Release 5 — day 35, dose 2

2021-03-14

Symptoms: Probably end stage frontal temporal dementia.

Healthcare visit (other): Hospice

Release 5 — day 42, dose 2

Reports this person's death

2021-03-19

Symptoms: Joyce passed away March 14, 2021.

Release 8 — 3 months, dose 2

2021-05-07

Symptoms: Joyce passed 03/14/2021

Healthcare visit (other): Trip to funeral home.

Release 11 — 12 months, dose 2

Reports this person's death

2022-02-05

Symptoms: Joyce died!

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	Death	✓	✓	✓
SD	Unevaluable event	✓	✓	✓
SRO	Cerebrovascular accident	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Seizure	✓	✓	✓

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