YQM-13387-75168

3 vaccinations 8 coded responses 21 check-ins 8 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 662 / KS
Registered: 2021-03-06

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

2021-02-10
Dose 1 — Pfizer-BioNTech
2021-03-03
Dose 2 — Pfizer-BioNTech
2021-03-06
Registered in v-safe
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-03-10
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-31
Survey response — day 28, dose 2
MedDRA: Fatigue — Feeling: Good

Free text: Just a naging sense of fatigue, not serious, just annoying.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — day 35, dose 2
MedDRA: Fatigue, Tinnitus — Feeling: Fair

Free text: Mild to moderate fatigue and worsened tinnitus

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-01
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-01
Dose 3 — Pfizer-BioNTech
2021-10-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-07
Survey response — days 1–6 daily, dose 3
MedDRA: Audiogram abnormal, Deafness neurosensory, Deafness unilateral, Office visit, Sudden hearing loss — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Sudden loss of hearing in left ear 2 days ago.Auditory exam results 12% hearing and 0% word recognition. · Healthcare visit (other): ENT Dept. visit, auditory exam and Dr exam with finding of ideopathic SNHLS

MedDRA releases: 2024-11 · check-in free text available
2021-10-07
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-08
Survey response — day 7, dose 3
MedDRA: Deafness unilateral, Sudden hearing loss — Feeling: Fair · Fever · Headache, Fatigue or tiredness

Free text: Ideopathic left ear sudden deafness (SSHL)

MedDRA releases: 2024-11 · check-in free text available
2021-10-15
Survey response — day 14, dose 3
MedDRA: Deafness unilateral, Tinnitus — Feeling: Good

Free text: The deafness that occurred suddenly in my left ear, with accompanying increased tinnitus, within 24 hours of receiving my Pfizer-BioNTech booster shot, continues unabated, if not worse.

MedDRA releases: 2024-11 · check-in free text available
2021-10-22
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-10-29
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-11-05
Survey response — day 35, dose 3
MedDRA: Deafness unilateral, Pre-existing disease, Tinnitus — Feeling: Fair

Free text: Continued deafness in left ear with worsening tinnitus in left ear.

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2021-12-07
Call 1 — Could Not Reach Participant
2021-12-10
Call 2 — Could Not Reach Participant
2022-01-02
Survey response — 3 months, dose 3
MedDRA: Disturbance in attention, Fatigue — Feeling: Fair

Free text: Fatigue, difficulty focusing attention.

MedDRA releases: 2024-11 · check-in free text available
2022-04-01
Survey response — 6 months, dose 3
MedDRA: Bronchitis bacterial, Office visit, Otitis externa, Upper respiratory tract infection bacterial — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Bacterial caused bronchitis and upper respiratory tract infection. Also, an infection on the top outer rim of my left ear. · Healthcare visit (other): Primary Care physician office visit

MedDRA releases: 2024-11 · check-in free text available
2022-04-01
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-04
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-10	Pfizer-BioNTech
2	2021-03-03	Pfizer-BioNTech
3	2021-10-01	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-10-07	Unsuccessful
2022-04-01	Unsuccessful

Free text

Release 6 — day 28, dose 2

2021-03-31

Symptoms: Just a naging sense of fatigue, not serious, just annoying.

Release 7 — day 35, dose 2

2021-04-07

Symptoms: Mild to moderate fatigue and worsened tinnitus

Release 10 — days 1–6 daily, dose 3

2021-10-07

Systemic reaction (other): Sudden loss of hearing in left ear 2 days ago.Auditory exam results 12% hearing and 0% word recognition.

Healthcare visit (other): ENT Dept. visit, auditory exam and Dr exam with finding of ideopathic SNHLS

Release 10 — day 7, dose 3

2021-10-08

Systemic reaction (other): Ideopathic left ear sudden deafness (SSHL)

Release 10 — day 14, dose 3

2021-10-15

Symptoms: The deafness that occurred suddenly in my left ear, with accompanying increased tinnitus, within 24 hours of receiving my Pfizer-BioNTech booster shot, continues unabated, if not worse.

Release 10 — day 35, dose 3

2021-11-05

Symptoms: Continued deafness in left ear with worsening tinnitus in left ear.

Release 10 — 3 months, dose 3

2022-01-02

Symptoms: Fatigue, difficulty focusing attention.

Release 11 — 6 months, dose 3

2022-04-01

Symptoms: Bacterial caused bronchitis and upper respiratory tract infection. Also, an infection on the top outer rim of my left ear.

Healthcare visit (other): Primary Care physician office visit

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	Deafness neurosensory	·	·	✓
HCVO	Office visit	·	·	✓
SD	Bronchitis bacterial	·	·	✓
SD	Deafness unilateral	·	·	✓
SD	Disturbance in attention	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Otitis externa	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Tinnitus	✓	✓	✓
SD	Upper respiratory tract infection bacterial	·	·	✓
SRO	Audiogram abnormal	·	·	✓
SRO	Deafness unilateral	·	·	✓
SRO	Sudden hearing loss	·	·	✓

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