Y6H-31459-74114

2 vaccinations 9 coded responses 23 check-ins 9 free-text entries 4 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 220 / VA
Registered: 2021-01-10

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

2021-01-10
Registered in v-safe
2021-01-10
Dose 1 — Pfizer-BioNTech
2021-01-10
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-11
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good · Site: Pain · Nausea

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-15
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Poor · Fatigue or tiredness · Be unable to work

Free text: Shortness in breathing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Report sent to call center — days 1–6 daily, dose 1
Be unable to work

1 call case(s)
2021-01-17
Survey response — day 7, dose 1
MedDRA: Dyspnoea — Feeling: Poor · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Difficulty in breathing , in bed and during making small effort to walk

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Report sent to call center — day 7, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-24
Survey response — day 14, dose 1
MedDRA: Dizziness postural, Dyspnoea, Fatigue, Insomnia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Very heavy breathing at night. I was forcing my self to breath . Unable to sleep for 3 nights ( 2 hrs sleep /night. Dizziness if I stay standing.I had same symptoms on 4/20 when I had Covid 19 in the critical care unit.tired most of the timecytokine?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Dose 2 — Pfizer-BioNTech
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

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

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-02-07
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-16
Survey response — day 14, dose 2
MedDRA: Dyspnoea, Fatigue, Pre-existing disease — Feeling: Poor · Be unable to work

Free text: Heavy breathing in bed at night when i lay down . I had to sit to be able to breath. Very tired from walking 2 -3 yards. The problem is either fro lungs or from heart condition.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-01
Survey response — day 28, dose 2
MedDRA: Chest pain, Dyspnoea, Fatigue, Heart rate increased — Feeling: Poor · Be unable to do your normal daily activities

Free text: Its hard to breath especially at night when I lay down in bed. Fatigue. Pain in chest. High pulse in 90 s.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — day 35, dose 2
MedDRA: Dyspnoea, Wheezing — Feeling: Poor · Be unable to do your normal daily activities

Free text: I cant breath in sleeping position. I have heavy breathing if I walk 2 yards. Very bad shortness of breath.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Survey response — day 42, dose 2
MedDRA: Cardiac failure congestive, Dyspnoea, Pulmonary oedema — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Congestive heart failure. Shortness of breath because of fluid in lungs.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-04
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-30
Call 1 — Left Voicemail
2021-08-01
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-01-31
Survey response — 12 months, dose 2
MedDRA: COVID-19 — Feeling: Fair · Be unable to work or attend school

Free text: Covid 19

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-10	Pfizer-BioNTech
2	2021-01-31	Pfizer-BioNTech

Call center

Reported	Outcome	VAERS-related outcome
2021-01-15	priority 2/3
2021-01-16	priority 2/3
2021-01-17	priority 2/3
2021-03-14	Unsuccessful

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-11

Systemic reaction (other): No

Release 2 — days 1–6 daily, dose 1

2021-01-16

Systemic reaction (other): Shortness in breathing

Release 2 — day 7, dose 1

2021-01-17

Systemic reaction (other): Difficulty in breathing , in bed and during making small effort to walk

Release 2 — day 14, dose 1

2021-01-24

Symptoms: Very heavy breathing at night. I was forcing my self to breath . Unable to sleep for 3 nights ( 2 hrs sleep /night. Dizziness if I stay standing.I had same symptoms on 4/20 when I had Covid 19 in the critical care unit.tired most of the timecytokine? cut off by CDC

Release 4 — day 14, dose 2

2021-02-16

Symptoms: Heavy breathing in bed at night when i lay down . I had to sit to be able to breath. Very tired from walking 2 -3 yards. The problem is either fro lungs or from heart condition.

Release 4 — day 28, dose 2

2021-03-01

Symptoms: Its hard to breath especially at night when I lay down in bed. Fatigue. Pain in chest. High pulse in 90 s.

Release 5 — day 35, dose 2

2021-03-07

Symptoms: I cant breath in sleeping position. I have heavy breathing if I walk 2 yards. Very bad shortness of breath.

Release 5 — day 42, dose 2

2021-03-14

Symptoms: Congestive heart failure. Shortness of breath because of fluid in lungs.

Release 11 — 12 months, dose 2

2022-01-31

Symptoms: Covid 19

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
SD	Cardiac failure congestive	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Dizziness postural	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Heart rate increased	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pulmonary oedema	✓	✓	✓
SD	Wheezing	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Unevaluable event	○	○	○

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