YVM-30292-08524

3 vaccinations 8 coded responses 29 check-ins 8 free-text entries 4 call cases

Sex: Male
Age at first dose: 61-65
ZIP prefix: 113 / NY
Registered: 2021-03-12

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

2021-03-12
Registered in v-safe
2021-03-12
Dose 1 — Janssen/Johnson & Johnson
2021-03-12
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-19
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 21, single dose
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 28, single dose
Feeling: Fair

Adult check-in
2021-04-16
Health check-in — day 35, single dose
Feeling: Good

Adult check-in
2021-04-23
Health check-in — day 42, single dose
Feeling: Good

Adult check-in
2021-06-11
Survey response — 3 months, dose 1
MedDRA: Influenza like illness, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Had very mild flu like symptoms about a month ago but they have been gone for weeks · Healthcare visit (other): In person alternative health care

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-11
Report sent to call center — 3 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-15
Call 1 — Left Voicemail
2021-09-10
Survey response — 6 months, dose 1
MedDRA: Renal colic, Tendon injury — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Nothing to do with Covid. I had a kidney stone attack. Also an Achilles tendon injury

MedDRA releases: 2024-11 · check-in free text available
2021-09-10
Report sent to call center — 6 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-13
Call 1 — Could Not Reach Participant
2021-09-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-09
Dose 2 — Pfizer-BioNTech
2022-03-14
Survey response — 12 months, dose 1
MedDRA: Discomfort, Fatigue, Post procedural inflammation, Renal stone removal — Feeling: Good · 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

Free text: I had my booster on 12/9. I was extremely fatigued for a few days. I had a kidney stone removal procedure 3 weeks earlier and I believe the Covid 19 booster shot inflamed the surgical area which caused discomfort for weeks after

MedDRA releases: 2024-11 · check-in free text available
2022-03-14
Report sent to call center — 12 months, dose 1
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 · 1 call case(s)
2022-03-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-10-13
Dose 3 — Pfizer-BioNTech
2022-10-14
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-10-16
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-10-17
Survey response — days 1–6 daily, dose 3
MedDRA: Feeling hot — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Warmth in the genital area

MedDRA releases: 2024-11 · check-in free text available
2022-10-18
Survey response — days 1–6 daily, dose 3
MedDRA: Feeling hot, Musculoskeletal discomfort — Feeling: Good

Free text: Warmth/discomfort in my groin area

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Survey response — days 1–6 daily, dose 3
MedDRA: Feeling hot, Musculoskeletal discomfort — Feeling: Good

Free text: Warmth and discomfort in my groin area

MedDRA releases: 2024-11 · check-in free text available
2022-10-20
Survey response — day 7, dose 3
MedDRA: Feeling hot, Musculoskeletal discomfort — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Warmth and discomfort in my groin area

MedDRA releases: 2024-11 · check-in free text available
2022-10-20
Report sent to call center — day 7, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-21
Call 1 — Could Not Reach Participant
2022-10-26
Call successful
Not applicable - Accidental Reporting
2022-10-26
Call successful
Participant prefers to complete VAERS report online
2022-10-27
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-11-04
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-11-10
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-11-17
Survey response — day 35, dose 3
MedDRA: Fatigue, Pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: I feel tired and achey today

MedDRA releases: 2024-11 · check-in free text available
2022-11-24
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2023-01-12
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2023-04-13
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-12	Janssen/Johnson & Johnson
2	2021-12-09	Pfizer-BioNTech	No
3	2022-10-13	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-06-11	Successful 2022-10-26	Not applicable - Accidental Reporting
2021-09-10	Successful 2021-09-16	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-03-14	Successful 2022-03-16	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-10-20	Successful 2022-10-26	Participant prefers to complete VAERS report online

Free text

Release 9 — 3 months, dose 1

2021-06-11

Symptoms: Had very mild flu like symptoms about a month ago but they have been gone for weeks

Healthcare visit (other): In person alternative health care

Release 9 — 6 months, dose 1

2021-09-10

Symptoms: Nothing to do with Covid. I had a kidney stone attack. Also an Achilles tendon injury

Release 11 — 12 months, dose 1

2022-03-14

Symptoms: I had my booster on 12/9. I was extremely fatigued for a few days. I had a kidney stone removal procedure 3 weeks earlier and I believe the Covid 19 booster shot inflamed the surgical area which caused discomfort for weeks after

Release 12 — days 1–6 daily, dose 3

2022-10-17

Systemic reaction (other): Warmth in the genital area

2022-10-18

Systemic reaction (other): Warmth/discomfort in my groin area

2022-10-19

Systemic reaction (other): Warmth and discomfort in my groin area

Release 12 — day 7, dose 3

2022-10-20

Systemic reaction (other): Warmth and discomfort in my groin area

Release 12 — day 35, dose 3

2022-11-17

Symptoms: I feel tired and achey today

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	Discomfort	·	·	✓
SD	Fatigue	·	·	✓
SD	Influenza like illness	✓	✓	✓
SD	Pain	·	·	✓
SD	Post procedural inflammation	·	·	✓
SD	Renal colic	·	·	✓
SD	Renal stone removal	·	·	✓
SD	Tendon injury	·	·	✓
SRO	Feeling hot	·	·	✓
SRO	Musculoskeletal discomfort	·	·	✓

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