Z3A-14391-40208

5 vaccinations 7 coded responses 35 check-ins 7 free-text entries 2 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 604 / IL
Registered: 2021-03-30

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

2021-03-29
Dose 1 — Pfizer-BioNTech
2021-03-30
Registered in v-safe
2021-03-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-01
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
2021-04-02
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-04-05
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-12
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-19
Dose 2 — Pfizer-BioNTech
2021-04-19
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-20
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue, Somnolence — Feeling: Good · Site: Pain

Free text: Sleepiness, tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-26
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-03
Survey response — day 14, dose 2
MedDRA: Abdominal discomfort, Diarrhoea, Insomnia — Feeling: Good · Be unable to do your normal daily activities

Free text: Upset stomach, loose bowel movement, unable to get a restful night's sleep.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-17
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-24
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-31
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-19
Survey response — 3 months, dose 2
MedDRA: Blood glucose abnormal, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: After watching my blood sugars since the second vaccine, they have been bouncing around all over the place. Saw my PCP today and she suggested I report this irregularity. · Healthcare visit (other): Doctors office visit

MedDRA releases: 2024-11 · check-in free text available
2021-07-19
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-26
Call 1 — Left Voicemail
2021-10-18
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-25
Dose 3 — Pfizer-BioNTech
2022-04-20
Survey response — 12 months, dose 2
MedDRA: COVID-19, Respiratory syncytial virus infection — Feeling: Good · 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

Free text: 3 weeks after the booster I was diagnosed with Covid19. About 1 month after that I had RSV

MedDRA releases: 2024-11 · check-in free text available
2022-04-20
Report sent to call center — 12 months, dose 2
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 · 1 call case(s)
2022-04-21
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-18
Dose 4 — Pfizer-BioNTech
2022-05-21
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2022-05-23
Survey response — days 1–6 daily, dose 4
MedDRA: Pre-existing disease, Rash — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Rash appeared before vaccination but heightened afterwards

MedDRA releases: 2024-11 · check-in free text available
2022-05-24
Survey response — days 1–6 daily, dose 4
MedDRA: Pre-existing disease — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Mild and improving. Rash was present before the vaccination.

MedDRA releases: 2024-11 · check-in free text available
2022-05-25
Survey response — day 7, dose 4
MedDRA: Rash — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Rash is subsiding.

MedDRA releases: 2024-11 · check-in free text available
2022-06-01
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-08
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-15
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-22
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-29
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-17
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-16
Dose 5 — Pfizer-BioNTech
2022-11-18
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-29	Pfizer-BioNTech
2	2021-04-19	Pfizer-BioNTech
3	2021-10-25	Pfizer-BioNTech	No
4	2022-05-18	Pfizer-BioNTech	No
5	2022-10-16	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-19	Successful	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-20	Successful 2022-04-21	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-20

Systemic reaction (other): Sleepiness, tired

Release 8 — day 14, dose 2

2021-05-03

Symptoms: Upset stomach, loose bowel movement, unable to get a restful night's sleep.

Release 9 — 3 months, dose 2

2021-07-19

Symptoms: After watching my blood sugars since the second vaccine, they have been bouncing around all over the place. Saw my PCP today and she suggested I report this irregularity.

Healthcare visit (other): Doctors office visit

Release 11 — 12 months, dose 2

2022-04-20

Symptoms: 3 weeks after the booster I was diagnosed with Covid19. About 1 month after that I had RSV

Release 11 — days 1–6 daily, dose 4

2022-05-23

Systemic reaction (other): Rash appeared before vaccination but heightened afterwards

2022-05-24

Systemic reaction (other): Mild and improving. Rash was present before the vaccination.

Release 11 — day 7, dose 4

2022-05-25

Systemic reaction (other): Rash is subsiding.

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	Abdominal discomfort	✓	✓	✓
SD	Blood glucose abnormal	·	·	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Office visit	·	·	✓
SD	Respiratory syncytial virus infection	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Pre-existing disease	·	·	✓
SRO	Rash	·	·	✓
SRO	Somnolence	✓	✓	✓

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