Y8R-11473-10974

3 vaccinations 8 coded responses 18 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 303 / GA
Registered: 2021-04-29

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-04-08
Dose 1 — Pfizer-BioNTech
2021-04-29
Registered in v-safe
2021-04-29
Dose 2 — Pfizer-BioNTech
2021-04-29
Survey response — day 0, dose 2
MedDRA: Headache — Feeling: Fair · Site: Pain · Headache, Joint pains · Be unable to work

Free text: head pounding

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-01
Survey response — days 1–6 daily, dose 2
MedDRA: Burning sensation — Feeling: Fair · Site: Pain · Headache

Free text: Burning under my arm pits

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-05-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-05-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-05-05
Survey response — days 1–6 daily, dose 2
MedDRA: Sleep disorder, Toothache — Feeling: Fair · Chills, Abdominal pain

Free text: woke at night and all the teeth in my mouth were hurting

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-05-13
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-20
Survey response — day 21, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-06-03
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-06-10
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-29
Survey response — 3 months, dose 2
MedDRA: Hypersomnia — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sleeping a lot

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-29
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-10
Call 1 — Left Voicemail
2021-08-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-28
Survey response — 6 months, dose 2
MedDRA: Chills, Dyspnoea, Pneumothorax, Unevaluable event — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Chills, difficulty breathing, partial collapse of the right and left lungs... After receiving the flu shot at Piedmont Atlanta, Dr. (b)(6). · Healthcare visit (other): Messaged my PCM and my Pulmonary Dr. (b)(6).

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Report sent to call center — 6 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

1 call case(s)
2021-11-01
Call 1 — Left Voicemail
2021-11-04
Call 2 — Left Voicemail
2021-11-04
Call successful
Participant prefers to complete VAERS report online
2022-01-01
Dose 3 — Pfizer-BioNTech
2022-04-29
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-07-02
Survey response — 6 months, dose 3
MedDRA: Pneumothorax — Feeling: Fair · 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

Free text: partially collapsed lungs bilateral after receiving second covid vaccine and, subsequently, the flu short. Happened after the flu shot.

MedDRA releases: 2024-11 · check-in free text available
2022-07-02
Report sent to call center — 6 months, 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 · 1 call case(s)
2022-07-05
Call 1 — Left Voicemail
2023-01-01
Survey response — 12 months, dose 3
MedDRA: Bronchitis, Sinusitis — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-08	Pfizer-BioNTech
2	2021-04-29	Pfizer-BioNTech
3	2022-01-01	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-29	Successful 2021-08-10	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-10-28	Successful 2021-11-04	Participant prefers to complete VAERS report online
2022-07-02	Unsuccessful

Free text

Release 8 — day 0, dose 2

2021-04-29

Systemic reaction (other): head pounding

Release 8 — days 1–6 daily, dose 2

2021-05-01

Systemic reaction (other): Burning under my arm pits

2021-05-05

Systemic reaction (other): woke at night and all the teeth in my mouth were hurting

Release 8 — day 21, dose 2

2021-05-20

Symptoms: Tiredness

Release 9 — 3 months, dose 2

2021-07-29

Symptoms: Sleeping a lot

Release 10 — 6 months, dose 2

2021-10-28

Symptoms: Chills, difficulty breathing, partial collapse of the right and left lungs... After receiving the flu shot at Piedmont Atlanta, Dr. (b)(6).

Healthcare visit (other): Messaged my PCM and my Pulmonary Dr. (b)(6).

redacted (b)(6)

Release 12 — 6 months, dose 3

2022-07-02

Symptoms: partially collapsed lungs bilateral after receiving second covid vaccine and, subsequently, the flu short. Happened after the flu shot.

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	Bronchitis	·	·	✓
SD	Chills	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Hypersomnia	✓	·	✓
SD	Pneumothorax	·	·	✓
SD	Sinusitis	·	·	✓
SRO	Burning sensation	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Sleep disorder	✓	✓	✓
SRO	Toothache	✓	✓	✓

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