YMJ-22687-93049

4 vaccinations 11 coded responses 36 check-ins 10 free-text entries 4 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 535 / WI
Registered: 2021-03-16

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

2021-03-13
Dose 1 — Pfizer-BioNTech
2021-03-16
Registered in v-safe
2021-03-16
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Pre-existing disease — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: I have chronic fatigue so hard to say what is causing fatigue today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-20
Health check-in — day 7, dose 1
Feeling: Good · Headache

Adult check-in
2021-03-27
Survey response — day 14, dose 1
MedDRA: Diarrhoea, Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue again 3/24/21Diarrhea 3/26 and 3/27/2021

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Dose 2 — Pfizer-BioNTech
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Nasal congestion — Feeling: Fair · Headache

Free text: Nasal Congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Diarrhea

Adult check-in
2021-04-10
Health check-in — day 7, dose 2
Feeling: Fair · Headache

Adult check-in
2021-04-17
Survey response — day 14, dose 2
MedDRA: Diarrhoea, Eye pain, Headache, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Headaches, eye aches,occasional short term fevers up to 100 F, bouts of diarrhea.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-05
Survey response — 3 months, dose 2
MedDRA: Cough, Respiratory tract congestion — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Chest congestion and cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-05
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-08
Call 1 — Left Voicemail
2021-08-30
Dose 3 — Pfizer-BioNTech
2021-09-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fever · Fatigue or tiredness

Adult check-in
2021-09-03
Survey response — days 1–6 daily, dose 3
MedDRA: Diarrhoea — Feeling: Fair · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Most of these were late last night. Right now I have diarrhea.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-06
Health check-in — day 7, dose 3
Feeling: Poor · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · 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

Adult check-in
2021-09-06
Report sent to call center — day 7, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-08
Call 1 — Left Voicemail
2021-09-13
Survey response — day 14, dose 3
MedDRA: Cough, Fatigue — Feeling: Poor · Be unable to do your normal daily activities

Free text: ExhaustionCoughing

MedDRA releases: 2024-11 · check-in free text available
2021-09-20
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-09-27
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-10-04
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-10-11
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2021-11-29
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-28
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-03
Dose 4 — Moderna
2022-04-14
Survey response — day 7, dose 4
MedDRA: Malaise — Feeling: Good

Free text: Felt sick, all over, the day after getting the 4th shot.

MedDRA releases: 2024-11 · check-in free text available
2022-04-17
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-24
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-01
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-08
Survey response — day 35, dose 4
MedDRA: Respiratory tract congestion — Feeling: Fair

Free text: Fairly severe chest congestion.

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Survey response — day 42, dose 4
MedDRA: Bronchitis, Medical counselling, Respiratory tract infection — Feeling: Fair · 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: Symptoms: Bronchitis or other respiratory infection · Healthcare visit (other): Phone Call

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Report sent to call center — day 42, dose 4
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)
2022-05-18
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-18
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-18
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-03
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-02
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-03
Survey response — 12 months, dose 4
MedDRA: COVID-19 — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-04-03
Report sent to call center — 12 months, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2023-04-04
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-13	Pfizer-BioNTech
2	2021-04-03	Pfizer-BioNTech
3	2021-08-30	Pfizer-BioNTech	No
4	2022-04-03	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-05	Successful 2022-05-18	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-09-06	Successful 2022-05-18	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-17	Successful 2022-05-18	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-03	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-16

Systemic reaction (other): I have chronic fatigue so hard to say what is causing fatigue today.

Release 6 — day 14, dose 1

2021-03-27

Symptoms: Fatigue again 3/24/21Diarrhea 3/26 and 3/27/2021

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): Nasal Congestion

Release 7 — day 14, dose 2

2021-04-17

Symptoms: Headaches, eye aches,occasional short term fevers up to 100 F, bouts of diarrhea.

Release 9 — 3 months, dose 2

2021-07-05

Symptoms: Chest congestion and cough

Release 9 — days 1–6 daily, dose 3

2021-09-03

Systemic reaction (other): Most of these were late last night. Right now I have diarrhea.

Release 9 — day 14, dose 3

2021-09-13

Symptoms: ExhaustionCoughing

Release 11 — day 7, dose 4

2022-04-14

Systemic reaction (other): Felt sick, all over, the day after getting the 4th shot.

Release 11 — day 35, dose 4

2022-05-08

Symptoms: Fairly severe chest congestion.

Release 11 — day 42, dose 4

2022-05-17

Symptoms: Bronchitis or other respiratory infection

Healthcare visit (other): Phone Call

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	Medical counselling	·	·	✓
SD	Bronchitis	·	·	✓
SD	Cough	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Eye pain	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Respiratory tract infection	·	·	✓
SRO	Diarrhoea	✓	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Malaise	·	·	✓
SRO	Nasal congestion	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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