Y95-27166-88913

3 vaccinations 14 coded responses 35 check-ins 14 free-text entries 3 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 922 / CA
Registered: 2021-06-22

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Registered dependents

XPT-32582-55995 Adult relative or friend · Female · 2021-07-14

Timeline

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

2021-06-22
Registered in v-safe
2021-06-22
Dose 1 — Pfizer-BioNTech
2021-06-22
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-06-23
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-06-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Nausea

Adult check-in
2021-06-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Nausea

Adult check-in
2021-06-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-06-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Nausea

Adult check-in
2021-06-29
Survey response — day 7, dose 1
MedDRA: Pain in extremity — Feeling: Good · Joint pains, Nausea

Free text: Calf pain intense

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-07-13
Dose 2 — Pfizer-BioNTech
2021-07-13
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-07-14
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-07-15
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Breathing issues had to breath

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-16
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea — Feeling: Good · Site: Pain · Headache

Free text: Slight breathing issue

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-07-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-07-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness, Nausea

Adult check-in
2021-07-20
Health check-in — day 7, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-07-27
Survey response — day 14, dose 2
MedDRA: Respiratory disorder — Feeling: Fair

Free text: Breathing issues

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-03
Survey response — day 21, dose 2
MedDRA: Eye irritation, Headache, Ocular hyperaemia, Renal pain — Feeling: Fair

Free text: Kidney area pain , right eye irritating, blood shot eye , headache

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-10
Survey response — day 28, dose 2
MedDRA: Eye irritation, Headache, Oropharyngeal pain — Feeling: Fair

Free text: Right eye irritated, sore throat and headache

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-08-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-10-14
Health check-in — 3 months, dose 2
Feeling: Poor

Adult check-in
2022-01-10
Dose 3 — Pfizer-BioNTech
2022-01-10
Health check-in — day 0, dose 3
Feeling: Good · Headache, Nausea

Adult check-in
2022-01-11
Survey response — days 1–6 daily, dose 3
MedDRA: SARS-CoV-2 test positive — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: After the booster I tested positive for Covid-19

MedDRA releases: 2024-11 · check-in free text available
2022-01-11
Report sent to call center — days 1–6 daily, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-01-12
Survey response — days 1–6 daily, dose 3
MedDRA: COVID-19 — 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: Positive for covid next day after booster

MedDRA releases: 2024-11 · check-in free text available
2022-01-13
Survey response — days 1–6 daily, dose 3
MedDRA: Respiratory disorder — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Breathing issues

MedDRA releases: 2024-11 · check-in free text available
2022-01-13
Call 1 — Could Not Reach Participant
2022-01-14
Survey response — days 1–6 daily, dose 3
MedDRA: Hypopnoea — Feeling: Fair · Site: Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Shallow breathing issues

MedDRA releases: 2024-11 · check-in free text available
2022-01-15
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Chills, Headache, Muscle or body aches, Nausea · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Adult check-in
2022-01-15
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-01-16
Survey response — days 1–6 daily, dose 3
MedDRA: Laboratory test abnormal — Feeling: Good · Fever · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Took test still positive

MedDRA releases: 2024-11 · check-in free text available
2022-01-17
Survey response — day 7, dose 3
MedDRA: Cough, Rhinorrhoea — Feeling: Fair · Fever · Chills, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Running nose coughing

MedDRA releases: 2024-11 · check-in free text available
2022-01-17
Report sent to call center — day 7, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-01-17
Call 1 — Could Not Reach Participant
2022-01-18
Call 1 — Could Not Reach Participant
2022-01-21
Call 2 — Could Not Reach Participant
2022-01-24
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-01-31
Survey response — day 21, dose 3
MedDRA: Injection site pain — Feeling: Good

Free text: Soreness at injection sight , kind of strange since is been awhile.

MedDRA releases: 2024-11 · check-in free text available
2022-02-07
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-14
Survey response — day 35, dose 3
MedDRA: Back disorder, Back pain, Injection site pain, Spinal operation — Feeling: Fair · Be unable to do your normal daily activities

Free text: Injection site sore still , experiencing severe back pain unlike the back pain I'm used to . It feels like someone stuck to knives in center of Back and spread my back apart Severe back issues from back surgery but the pain is not the same at all mor

MedDRA releases: 2024-11 · check-in free text available
2022-02-22
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-06-22	Pfizer-BioNTech	No
2	2021-07-13	Pfizer-BioNTech	No
3	2022-01-10	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-01-11	Unsuccessful
2022-01-15	Unsuccessful
2022-01-17	Unsuccessful

Free text

Release 9 — day 7, dose 1

2021-06-29

Systemic reaction (other): Calf pain intense

Release 9 — days 1–6 daily, dose 2

2021-07-15

Systemic reaction (other): Breathing issues had to breath

2021-07-16

Systemic reaction (other): Slight breathing issue

Release 9 — day 14, dose 2

2021-07-27

Symptoms: Breathing issues

Release 9 — day 21, dose 2

2021-08-03

Symptoms: Kidney area pain , right eye irritating, blood shot eye , headache

Release 9 — day 28, dose 2

2021-08-10

Symptoms: Right eye irritated, sore throat and headache

Release 10 — days 1–6 daily, dose 3

2022-01-11

Systemic reaction (other): After the booster I tested positive for Covid-19

2022-01-12

Systemic reaction (other): Positive for covid next day after booster

2022-01-13

Systemic reaction (other): Breathing issues

2022-01-14

Systemic reaction (other): Shallow breathing issues

2022-01-16

Systemic reaction (other): Took test still positive

Release 10 — day 7, dose 3

2022-01-17

Systemic reaction (other): Running nose coughing

Release 11 — day 21, dose 3

2022-01-31

Symptoms: Soreness at injection sight , kind of strange since is been awhile.

Release 11 — day 35, dose 3

2022-02-14

Symptoms: Injection site sore still , experiencing severe back pain unlike the back pain I'm used to . It feels like someone stuck to knives in center of Back and spread my back apart Severe back issues from back surgery but the pain is not the same at all mor cut off by CDC

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	Back disorder	·	·	✓
SD	Back pain	·	·	✓
SD	Eye irritation	✓	·	✓
SD	Headache	✓	·	✓
SD	Injection site pain	·	·	✓
SD	Ocular hyperaemia	✓	·	✓
SD	Oropharyngeal pain	✓	·	✓
SD	Renal pain	✓	·	✓
SD	Respiratory disorder	✓	·	✓
SD	Spinal operation	·	·	✓
SRO	Cough	·	·	✓
SRO	COVID-19	·	·	✓
SRO	Dyspnoea	✓	·	✓
SRO	Hypopnoea	·	·	✓
SRO	Laboratory test abnormal	·	·	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Respiratory disorder	·	·	✓
SRO	Rhinorrhoea	·	·	✓
SRO	SARS-CoV-2 test positive	·	·	✓

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