Y4R-22605-90982

5 vaccinations 12 coded responses 37 check-ins 12 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 983 / WA
Registered: 2021-01-21

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

2021-01-21
Registered in v-safe
2021-01-21
Dose 1 — Pfizer-BioNTech
2021-01-21
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Itching · Joint pains, Muscle or body aches, Abdominal pain, Rash, not including the immediate area around the injection site

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-26
Survey response — days 1–6 daily, dose 1
MedDRA: Adverse reaction, Hypersensitivity — Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: I am a tiny person - under 100 pounds. Could my Side effects be slightly greater slightly longer because of my small size? Should I have waited for a child size those?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Good · Joint pains

Free text: I weigh less than 100 pounds. Does that make side effects stronger?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Survey response — day 14, dose 1
MedDRA: Decreased appetite — Feeling: Good · Be unable to do your normal daily activities

Free text: I realize that my appetite has been down a bit. I did not think to mention that earlier and I believe it is much better. I was never nauseous, but looking back I didnt eat much the first few days. Partly, of course, I didnt have the energy to c

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Dose 2 — Pfizer-BioNTech
2021-02-09
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Not hungry. I only weigh 100 lbs. can my low body weight make symptoms more intense?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 2
MedDRA: Hyperhidrosis, Pyrexia — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Symptoms very bad last night. Fever (did not take highest temperature), bad sweating, fever broke and I woke up feeling much better.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-16
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-02
Survey response — day 21, dose 2
MedDRA: Feeling hot, Flushing — Feeling: Fair

Free text: In hindsight I feel a bit warm and flushed for a few minutes most afternoons. I dont seem to register much of any temperature. It might be .4 above normal but goes away quickly.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-23
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-11
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Back pain, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I needed to see a chiropractor for pain in my right lower back and hip. I doubt its related to my vaccination. · Healthcare visit (other): Chiropractor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-10
Survey response — 6 months, dose 2
MedDRA: Medical counselling, Oral pain, Stomatitis, Tooth restoration, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Minor but real. I had a dental procedure that should have been simple but a week later pain remained. The dentist said I had mouth sores that seem to be occasionally connected with Covid vaccine. The sores healed and pain dissipated within 10 days. · Healthcare visit (other): Dental gum line filling.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-10
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-18
Call 1 — Left Voicemail
2021-08-20
Callback requested for
02:30PM ET
2021-08-20
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-09
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2022-02-09
Dose 4 — Moderna
2022-02-09
Survey response — 12 months, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Some fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-05-11
Survey response — 3 months, dose 4
MedDRA: Eye disorder — Feeling: Fair

Free text: Odd occasional thrum over right eye.

MedDRA releases: 2024-11 · check-in free text available
2022-08-10
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2022-09-16
Dose 5 — Pfizer-BioNTech
Co-administered: Flu
2022-09-21
Survey response — days 1–6 daily, dose 5
MedDRA: Contusion, Fatigue, Pain in extremity — Feeling: Good · Site: Redness

Free text: Please note that I tried to give daily reports since September 16. Hid a sore arm the 17th and slight fatigue.Since then and today my arm is bruised.

MedDRA releases: 2024-11 · check-in free text available
2022-09-22
Survey response — days 1–6 daily, dose 5
MedDRA: Arthralgia, Pre-existing disease — Feeling: Good · Joint pains · Be unable to do your normal daily activities

Free text: Right hand joint pain too much to hold a coffee cup. Put on a brace. Not likely related to shot in left arm. I have arthritis.Used other hand all day

MedDRA releases: 2024-11 · check-in free text available
2022-09-23
Health check-in — day 7, dose 5
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-01
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-07
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-10-16
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-10-21
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-10-29
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-17
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-03-18
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Pfizer-BioNTech
2	2021-02-09	Pfizer-BioNTech
3	2021-10-09	Pfizer-BioNTech	Flu
4	2022-02-09	Moderna	No
5	2022-09-16	Pfizer-BioNTech	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-05-11	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-10	Successful 2021-08-20	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-26

Systemic reaction (other): I am a tiny person - under 100 pounds. Could my Side effects be slightly greater slightly longer because of my small size? Should I have waited for a child size those?

2021-01-27

Systemic reaction (other): I weigh less than 100 pounds. Does that make side effects stronger?

Release 3 — day 14, dose 1

2021-02-04

Symptoms: I realize that my appetite has been down a bit. I did not think to mention that earlier and I believe it is much better. I was never nauseous, but looking back I didnt eat much the first few days. Partly, of course, I didnt have the energy to c

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): Not hungry. I only weigh 100 lbs. can my low body weight make symptoms more intense?

2021-02-11

Systemic reaction (other): Symptoms very bad last night. Fever (did not take highest temperature), bad sweating, fever broke and I woke up feeling much better.

Release 4 — day 21, dose 2

2021-03-02

Symptoms: In hindsight I feel a bit warm and flushed for a few minutes most afternoons. I dont seem to register much of any temperature. It might be .4 above normal but goes away quickly.

Release 8 — 3 months, dose 2

2021-05-11

Symptoms: I needed to see a chiropractor for pain in my right lower back and hip. I doubt its related to my vaccination.

Healthcare visit (other): Chiropractor

Release 9 — 6 months, dose 2

2021-08-10

Symptoms: Minor but real. I had a dental procedure that should have been simple but a week later pain remained. The dentist said I had mouth sores that seem to be occasionally connected with Covid vaccine. The sores healed and pain dissipated within 10 days. cut off by CDC

Healthcare visit (other): Dental gum line filling.

Release 11 — 12 months, dose 2

2022-02-09

Symptoms: Some fatigue

Release 11 — 3 months, dose 4

2022-05-11

Symptoms: Odd occasional thrum over right eye.

Release 12 — days 1–6 daily, dose 5

2022-09-21

Systemic reaction (other): Please note that I tried to give daily reports since September 16. Hid a sore arm the 17th and slight fatigue.Since then and today my arm is bruised.

2022-09-22

Systemic reaction (other): Right hand joint pain too much to hold a coffee cup. Put on a brace. Not likely related to shot in left arm. I have arthritis.Used other hand all day

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	✓	✓	✓
HCVO	Tooth restoration	✓	·	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Decreased appetite	✓	✓	✓
SD	Eye disorder	·	·	✓
SD	Fatigue	·	·	✓
SD	Feeling hot	✓	✓	✓
SD	Flushing	✓	✓	✓
SD	Medical counselling	✓	·	✓
SD	Office visit	·	·	✓
SD	Oral pain	✓	·	✓
SD	Stomatitis	✓	·	✓
SD	Unevaluable event	✓	·	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Arthralgia	·	·	✓
SRO	Contusion	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Hypersensitivity	○	✓	○
SRO	Pain in extremity	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Pyrexia	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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