YCR-59289-60435

2 vaccinations 5 coded responses 25 check-ins 5 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 541 / WI
Registered: 2021-01-30

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

2021-01-30
Registered in v-safe
2021-01-30
Dose 1 — Pfizer-BioNTech
2021-01-30
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-31
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling abnormal, Insomnia — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Kind of feel out of it. Hard time sleeping.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-06
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-13
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-02-20
Dose 2 — Pfizer-BioNTech
2021-02-20
Health check-in — day 0, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-02-27
Health check-in — day 7, dose 2
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-06
Survey response — day 14, dose 2
MedDRA: Blood test abnormal, Office visit — Feeling: Fair

Free text: Blood levels off. Dr working on.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-20
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-27
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-03
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-22
Survey response — 3 months, dose 2
MedDRA: Anaemia vitamin B12 deficiency, Blood homocysteine increased, Blood test abnormal, Office visit, Thrombosis, Vitamin B12 deficiency — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Symptoms: Off blood work. Showing B12 deficient and B12 anemic. Also high homocysteine. Dont think its anything to do with vaccine. Have small blood clot in left leg that watching but is in the vein. Doctors are monitoring me close. · Healthcare visit (other): Regular Doctor office visit on 6/19/2021

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-22
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-21
Survey response — 6 months, dose 2
MedDRA: Adrenal insufficiency, Laboratory test abnormal, Office visit, Pre-existing disease — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Symptoms: Adrenal glands are fatigued according to recent lab work. Also other labs off. · Healthcare visit (other): Regular 2 month Doctor appt. may be referred to Endocrinologist. Many of these health issues going on before vaccine. Adrenal glands are recent though.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-21
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-24
Call 1 — Left Voicemail
2022-02-20
Survey response — 12 months, dose 2
MedDRA: Cardiac disorder, Gastrointestinal disorder — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: GI and Heart issues but nothing to do with the shot.

MedDRA releases: 2024-11 · check-in free text available
2022-02-20
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-21
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-30	Pfizer-BioNTech
2	2021-02-20	Pfizer-BioNTech

Call center

Reported	Outcome	VAERS-related outcome
2021-05-22	Unsuccessful
2021-08-21	Unsuccessful
2022-02-20	Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 1

2021-01-31

Systemic reaction (other): Kind of feel out of it. Hard time sleeping.

Release 5 — day 14, dose 2

2021-03-06

Symptoms: Blood levels off. Dr working on.

Release 8 — 3 months, dose 2

2021-05-22

Symptoms: Off blood work. Showing B12 deficient and B12 anemic. Also high homocysteine. Dont think its anything to do with vaccine. Have small blood clot in left leg that watching but is in the vein. Doctors are monitoring me close.

Healthcare visit (other): Regular Doctor office visit on 6/19/2021

Release 9 — 6 months, dose 2

2021-08-21

Symptoms: Adrenal glands are fatigued according to recent lab work. Also other labs off.

Healthcare visit (other): Regular 2 month Doctor appt. may be referred to Endocrinologist. Many of these health issues going on before vaccine. Adrenal glands are recent though.

Release 11 — 12 months, dose 2

2022-02-20

Symptoms: GI and Heart issues but nothing to do with the 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	Office visit	✓	✓	✓
HCVO	Pre-existing disease	✓	·	✓
SD	Adrenal insufficiency	✓	·	✓
SD	Anaemia vitamin B12 deficiency	✓	✓	✓
SD	Blood homocysteine increased	✓	✓	✓
SD	Blood test abnormal	✓	✓	✓
SD	Cardiac disorder	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Laboratory test abnormal	✓	·	✓
SD	Office visit	✓	✓	✓
SD	Thrombosis	✓	✓	✓
SD	Vitamin B12 deficiency	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Insomnia	✓	✓	✓

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