YW2-26122-22049

4 vaccinations 7 coded responses 43 check-ins 6 free-text entries 1 call case

Sex: Male
Age at first dose: 66+
ZIP prefix: 210 / MD
Registered: 2021-01-20

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

2021-01-20
Registered in v-safe
2021-01-20
Dose 1 — Pfizer-BioNTech
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Survey response — days 1–6 daily, dose 1
MedDRA: Pulmonary pain — Feeling: Good · Fatigue or tiredness

Free text: Tightness in upper lobes of both lungs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-10
Dose 2 — Pfizer-BioNTech
2021-02-10
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-11
Survey response — days 1–6 daily, dose 2
MedDRA: Flatulence — Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness

Free text: Intestinal gas

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue, Pyrexia — Feeling: Good · Site: Pain · Fever · Fatigue or tiredness

Free text: After I responded yesterday I had a fever of 100.4 & was very tired. The fever abated after about 6 hours

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Middle ear effusion, Nasal congestion — Feeling: Good

Free text: Ive had a stuffy nose & fluid in my right ear for the past 4 days but know if its related to the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-12
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-12
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-09-27
Dose 3 — Pfizer-BioNTech
2021-09-30
Survey response — days 1–6 daily, dose 3
MedDRA: Chills — Feeling: Good · Chills

Free text: Had a brief mild chill just before bedtime 36 hours after the shot

MedDRA releases: 2024-11 · check-in free text available
2021-10-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

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

Adult check-in
2021-10-04
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-10-11
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-10-18
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-10-25
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-08
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-27
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-28
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-04
Dose 4 — Moderna
2022-04-15
Survey response — day 7, dose 4
MedDRA: Chills, Pain in extremity, Stupor — Feeling: Good

Free text: I had some responses from the vaccine, sore arm, torpor for about 24 hours & slight chill but no actual fever.

MedDRA releases: 2024-11 · check-in free text available
2022-04-18
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-25
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-02
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-09
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-16
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-04
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-03
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-06
Survey response — 12 months, dose 4
MedDRA: Arthropod bite, Borrelia test negative, Illness — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-06
Report sent to call center — 12 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-07
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	2021-01-20	Pfizer-BioNTech
2	2021-02-10	Pfizer-BioNTech
3	2021-09-27	Pfizer-BioNTech	No
4	2022-04-04	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2023-04-06	Successful 2023-04-07	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-26

Systemic reaction (other): Tightness in upper lobes of both lungs

Release 4 — days 1–6 daily, dose 2

2021-02-11

Systemic reaction (other): Intestinal gas

2021-02-12

Systemic reaction (other): After I responded yesterday I had a fever of 100.4 & was very tired. The fever abated after about 6 hours

2021-02-16

Systemic reaction (other): Ive had a stuffy nose & fluid in my right ear for the past 4 days but know if its related to the vaccine.

Release 9 — days 1–6 daily, dose 3

2021-09-30

Systemic reaction (other): Had a brief mild chill just before bedtime 36 hours after the shot

Release 11 — day 7, dose 4

2022-04-15

Systemic reaction (other): I had some responses from the vaccine, sore arm, torpor for about 24 hours & slight chill but no actual fever.

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
SD	Arthropod bite	·	·	✓
SD	Borrelia test negative	·	·	✓
SD	Illness	·	·	✓
SRO	Chills	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Flatulence	✓	✓	✓
SRO	Middle ear effusion	✓	✓	✓
SRO	Nasal congestion	✓	✓	✓
SRO	Pain in extremity	·	·	✓
SRO	Pulmonary pain	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Stupor	·	·	✓

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