Y64-26581-15625

4 vaccinations 9 coded responses 11 check-ins 8 free-text entries 5 call cases

Sex: —
Age at first dose: 36-40
ZIP prefix: 393 / MS
Registered: 2021-09-25

Relationship: Self
Race: N/A
Ethnicity: N/A

Timeline

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

2021-07-27
Dose 1 — Other-Unknown
2021-08-17
Dose 2 — Pfizer-BioNTech
2021-09-25
Registered in v-safe
2021-09-25
Survey response — day 35, dose 2
MedDRA: Pain in extremity, Pre-existing disease — Feeling: Poor

Free text: I would say my arm feels a bit still kind of sore but hey I had surgery on my arm so I had broken one and then the other one I kind of sprung it basically so it makes sense that are the one doesn't feel so great but for the most part I'm okay though

MedDRA releases: 2024-11 · check-in free text available
2021-11-17
Survey response — 3 months, dose 2
MedDRA: Depressed mood, Stress — Feeling: Poor · 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: I'm stressed out of depressed by my environment like my environment is too loud at the same time if I wanted to be loud they get upset and my nutrition is really bad and are refused to you know be correctly so not the factor I guess..

MedDRA releases: 2024-11 · check-in free text available
2021-11-17
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

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)
2021-11-19
Call 1 — Could Not Reach Participant
2021-11-24
Call 2 — Could Not Reach Participant
2022-01-29
Dose 3 — Pfizer-BioNTech
2022-02-16
Survey response — day 14, dose 3
MedDRA: Abdominal pain upper, Depressed mood, Stress — 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: More stressed ,a little more depressed,and stomach pain is not pleasure..my diet violates people's rights.so it gets attack

MedDRA releases: 2024-11 · check-in free text available
2022-02-16
Survey response — 6 months, dose 2
MedDRA: Depressed mood — Feeling: Poor · 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: More depressed,

MedDRA releases: 2024-11 · check-in free text available
2022-02-16
Report sent to call center — day 14, dose 3
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)
2022-02-16
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

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)
2022-02-19
Survey response — day 21, dose 3
MedDRA: Pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Nothing serious but only a lot of soreness and returns and leaves and returns again

MedDRA releases: 2024-11 · check-in free text available
2022-02-21
Call 1 — Could Not Reach Participant
2022-02-24
Call 2 — Could Not Reach Participant
2022-03-01
Survey response — day 28, dose 3
MedDRA: Unevaluable event — Feeling: Poor

Free text: Never ok

MedDRA releases: 2024-11 · check-in free text available
2022-03-30
Dose 4 — Other-Unknown
Co-administered: Tetanus
2022-04-30
Survey response — 3 months, dose 3
MedDRA: Abdominal pain upper, Emergency care, Feeling abnormal — Feeling: Poor · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: I'm feeling very upset and seems like nobody cares about that so my emotional baggage is bad horrible my physical state is kind of bad because it's like my stomach is always hurting · Healthcare visit (other): In and out of the ER it's like I don't need anger management it's like people keep making you upset for no reason because they want to play as they say the white man's game

MedDRA releases: 2024-11 · check-in free text available
2022-04-30
Survey response — day 28, dose 4
MedDRA: Malaise — Feeling: Poor · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: I feel sicker

MedDRA releases: 2024-11 · check-in free text available
2022-04-30
Report sent to call center — day 28, dose 4
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-04-30
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-02
Call 1 — Could Not Reach Participant
2022-05-05
Call 2 — Could Not Reach Participant
2022-06-30
Health check-in — 3 months, dose 4
Feeling: Poor

Adult check-in
2022-09-28
Health check-in — 6 months, dose 4
Feeling: Poor

Adult check-in
2023-03-30
Survey response — 12 months, dose 4
MedDRA: Skin discolouration — Feeling: Poor

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-07-27	Other-Unknown	No
2	2021-08-17	Pfizer-BioNTech	No
3	2022-01-29	Pfizer-BioNTech	No
4	2022-03-30	Other-Unknown	Tetanus

Call center

Reported	Outcome	VAERS-related outcome
2021-11-17	Unsuccessful
2022-02-16	Unsuccessful
2022-02-16	Unsuccessful
2022-04-30	Unsuccessful
2022-04-30	Unsuccessful

Free text

Release 9 — day 35, dose 2

2021-09-25

Symptoms: I would say my arm feels a bit still kind of sore but hey I had surgery on my arm so I had broken one and then the other one I kind of sprung it basically so it makes sense that are the one doesn't feel so great but for the most part I'm okay though cut off by CDC

Release 10 — 3 months, dose 2

2021-11-17

Symptoms: I'm stressed out of depressed by my environment like my environment is too loud at the same time if I wanted to be loud they get upset and my nutrition is really bad and are refused to you know be correctly so not the factor I guess..

Release 11 — 6 months, dose 2

2022-02-16

Symptoms: More depressed,

Release 11 — day 14, dose 3

2022-02-16

Symptoms: More stressed ,a little more depressed,and stomach pain is not pleasure..my diet violates people's rights.so it gets attack

Release 11 — day 21, dose 3

2022-02-19

Symptoms: Nothing serious but only a lot of soreness and returns and leaves and returns again

Release 11 — day 28, dose 3

2022-03-01

Symptoms: Never ok

Release 11 — day 28, dose 4

2022-04-30

Symptoms: I feel sicker

Release 11 — 3 months, dose 3

2022-04-30

Symptoms: I'm feeling very upset and seems like nobody cares about that so my emotional baggage is bad horrible my physical state is kind of bad because it's like my stomach is always hurting

Healthcare visit (other): In and out of the ER it's like I don't need anger management it's like people keep making you upset for no reason because they want to play as they say the white man's game

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	Emergency care	·	·	✓
SD	Abdominal pain upper	·	·	✓
SD	Depressed mood	·	·	✓
SD	Feeling abnormal	·	·	✓
SD	Malaise	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Skin discolouration	·	·	✓
SD	Stress	·	·	✓
SD	Unevaluable event	·	·	✓

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