Y9W-17243-09492

3 vaccinations 9 coded responses 15 check-ins 9 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 581 / ND
Registered: 2021-08-27

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

2021-03-05
Dose 1 — Pfizer-BioNTech
2021-03-26
Dose 2 — Pfizer-BioNTech
2021-08-27
Registered in v-safe
2021-08-27
Dose 3 — Pfizer-BioNTech
2021-08-27
Survey response — day 0, dose 3
MedDRA: Dizziness, Visual acuity reduced — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: lightheaded, visual acuity blurred.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-08-29
Survey response — days 1–6 daily, dose 3
MedDRA: Musculoskeletal stiffness — Feeling: Fair · Site: Pain · Fever · Joint pains, Fatigue or tiredness

Free text: stiff neck

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-30
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness, Musculoskeletal stiffness — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: neck stiffness, lightheaded/dizzy

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-31
Survey response — days 1–6 daily, dose 3
MedDRA: Dizziness, Musculoskeletal stiffness, Neck pain — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: neck pain, stiffness & lightheaded

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-01
Survey response — days 1–6 daily, dose 3
MedDRA: Abdominal pain, Dizziness, Musculoskeletal stiffness — Feeling: Fair · Fatigue or tiredness

Free text: stiff neck, lightheaded, left sided abdominal pain

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-05
Survey response — day 7, dose 3
MedDRA: Dizziness, Rash — Feeling: Fair · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Rash on the back of my neck. lightheaded

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-10
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-09-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-09-24
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-10-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-10-08
Survey response — day 42, dose 3
MedDRA: Fatigue, Medical counselling, Mobility decreased, Somnolence — 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: Extreme fatigue. I asked my doc if we can consider Ritalin because I am having difficulties staying awake. Am in bed by most days by 6 pm.

MedDRA releases: 2024-11 · check-in free text available
2021-10-08
Report sent to call center — day 42, 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)
2021-11-05
Call 1 — Left Voicemail
2021-11-28
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-02-28
Survey response — 6 months, dose 3
MedDRA: Apathy, Fatigue, Office visit — 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: extreme fatigue, apathy, no motivation. Questioning if this is depression. · Healthcare visit (other): Regular clinic appt

MedDRA releases: 2024-11 · check-in free text available
2022-02-28
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

1 call case(s)
2022-03-01
Call 1 — Left Voicemail
2022-08-27
Survey response — 12 months, dose 3
MedDRA: Back pain, Hypoaesthesia, Intervertebral disc disorder, Pain in extremity — 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 · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: back & R) leg pain & numbness. It would appear that there is a problem with the L5 disc area that is causing all this.

MedDRA releases: 2024-11 · check-in free text available
2022-08-27
Report sent to call center — 12 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

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-08-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-05	Pfizer-BioNTech	No
2	2021-03-26	Pfizer-BioNTech	No
3	2021-08-27	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-10-08	Successful 2022-08-29	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-28	Successful 2022-08-29	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-27	Successful 2022-08-29	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 9 — day 0, dose 3

2021-08-27

Systemic reaction (other): lightheaded, visual acuity blurred.

Release 9 — days 1–6 daily, dose 3

2021-08-29

Systemic reaction (other): stiff neck

2021-08-30

Systemic reaction (other): neck stiffness, lightheaded/dizzy

2021-08-31

Systemic reaction (other): neck pain, stiffness & lightheaded

2021-09-01

Systemic reaction (other): stiff neck, lightheaded, left sided abdominal pain

Release 9 — day 7, dose 3

2021-09-05

Systemic reaction (other): Rash on the back of my neck. lightheaded

Release 10 — day 42, dose 3

2021-10-08

Symptoms: Extreme fatigue. I asked my doc if we can consider Ritalin because I am having difficulties staying awake. Am in bed by most days by 6 pm.

Release 11 — 6 months, dose 3

2022-02-28

Symptoms: extreme fatigue, apathy, no motivation. Questioning if this is depression.

Healthcare visit (other): Regular clinic appt

Release 12 — 12 months, dose 3

2022-08-27

Symptoms: back & R) leg pain & numbness. It would appear that there is a problem with the L5 disc area that is causing all this.

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	·	·	✓
SD	Apathy	·	·	✓
SD	Back pain	·	·	✓
SD	Fatigue	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Intervertebral disc disorder	·	·	✓
SD	Medical counselling	·	·	✓
SD	Mobility decreased	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Somnolence	·	·	✓
SRO	Abdominal pain	✓	·	✓
SRO	Dizziness	✓	·	✓
SRO	Musculoskeletal stiffness	✓	·	✓
SRO	Neck pain	✓	·	✓
SRO	Rash	✓	·	✓
SRO	Visual acuity reduced	✓	·	✓

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