Z4H-16240-75448

4 vaccinations 21 coded responses 43 check-ins 19 free-text entries 10 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 016 / MA
Registered: 2021-02-18

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

2021-02-17
Dose 1 — Pfizer-BioNTech
2021-02-18
Registered in v-safe
2021-02-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-03
Survey response — day 14, dose 1
MedDRA: Dermatitis atopic, Pre-existing disease, Pruritus — Feeling: Good

Free text: dermatitis type flare up Itchy backTreated with special cream

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Dose 2 — Pfizer-BioNTech
2021-03-10
Health check-in — day 0, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Chills

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Chills, Rash, not including the immediate area around the injection site

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Nasal congestion — Feeling: Good · Chills

Free text: nasal congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Arthritis, Pre-existing disease — Feeling: Good

Free text: arthritic left wrist flared up past week

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — day 7, dose 2
MedDRA: Chills — Feeling: Good · Chills, Joint pains

Free text: chills intermittently comes and goes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Survey response — day 14, dose 2
MedDRA: Cough, Nasal congestion — Feeling: Good

Free text: nasal congestion and dry cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — day 21, dose 2
MedDRA: Pre-existing disease, Seasonal allergy — Feeling: Good

Free text: Seasonal allergies...mild

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-21
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-09
Survey response — 3 months, dose 2
MedDRA: Hypersensitivity, Office visit, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Seasonal allergies, oab · Healthcare visit (other): primary care office visit and lab tests

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-09
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-28
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2021-09-08
Survey response — 6 months, dose 2
MedDRA: Hypertonic bladder, Office visit, Unevaluable event, Urinary tract infection — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: OAB and a UTIunder care of a urogynecologist · Healthcare visit (other): My primary care doctor referred me to urogynecologist. on 28th of August I got my Pfeizer booster and senior high dose flu shot and had no side effects

MedDRA releases: 2024-11 · check-in free text available
2021-09-08
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-09
Call 3 — Could Not Reach Participant
2021-10-02
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-10-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-11-27
Survey response — 3 months, dose 3
MedDRA: Nasal congestion, Pre-existing disease, Throat irritation — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Nasal congestion, scratchy throat; 6 month mark 11/22 for my series of 3 Synvisc knee shots

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-30
Call X — Left Voicemail
2022-02-26
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-08-28
Survey response — 12 months, dose 3
MedDRA: Asthma, Ear, nose and throat disorder, Office visit, SARS-CoV-2 test negative, Sinusitis — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Symptoms: Sinusitis and ear nose throat issues causing asthmatic symptoms. . Under doctor's care and on medications (no fever and test negative for C19) · Healthcare visit (other): Medical exam PCPdoctor and

MedDRA releases: 2024-11 · check-in free text available
2022-08-28
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-08-29
Call 3 — Left Voicemail
2022-08-29
Call 2 — Left Voicemail
2022-08-29
Call 3 — Left Voicemail
2022-08-29
Call 3 — Left Voicemail
2022-10-16
Dose 4 — Pfizer-BioNTech
Co-administered: Flu
2022-10-16
Survey response — day 0, dose 4
MedDRA: Nasal congestion — Feeling: Fair · Site: Pain, Itching · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: nasal congestion

MedDRA releases: 2024-11 · check-in free text available
2022-10-17
Survey response — days 1–6 daily, dose 4
MedDRA: Nasal congestion, Pre-existing disease — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Chills, Fatigue or tiredness

Free text: Lingering nadal congestion from seasonal allergies

MedDRA releases: 2024-11 · check-in free text available
2022-10-18
Survey response — days 1–6 daily, dose 4
MedDRA: Pre-existing disease — Feeling: Good · Site: Redness, Itching

Free text: As of 11/30/22 i will be considered a 5 year breast cancer survivor! I also have had MVR heart condition for8 years that I am monitored, tested, examined every 6 months. I get euflexxa shots both knees every 6 months for arthritis & meniscus. tears

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Survey response — days 1–6 daily, dose 4
MedDRA: Laryngitis, Nasal congestion, Office visit, Rhinitis allergic — Feeling: Fair · Site: Redness · Headache, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): perennial rhinitis, nasal congestion, voice box laryngitis · Healthcare visit (other): under current care ENT specialist with prescription nasal spray regimen and saline and continuing

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Report sent to call center — days 1–6 daily, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-20
Survey response — days 1–6 daily, dose 4
MedDRA: Rhinitis, Sinusitis — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: Tolerated both flu and bivalent! In August i had Prevnar 20 shot. i cutrently have a sinusitis/rhinitis flare up

MedDRA releases: 2024-11 · check-in free text available
2022-10-20
Call 3 — Left Voicemail
2022-10-21
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-22
Survey response — days 1–6 daily, dose 4
MedDRA: Rhinitis, Sinusitis — Feeling: Good

Free text: daily regimen for perennial rhinitis/sinusitis ordered by ENT doctor but unrelated to bivalent, flu or Prevnar shots. Taking daily 1-2 mile slow walks getting 5k to 6k steps therfore doing fine!

MedDRA releases: 2024-11 · check-in free text available
2022-10-23
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-10-30
Survey response — day 14, dose 4
MedDRA: Hypertonic bladder, Urinary tract infection — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: O A B. UTI . on antibiotics

MedDRA releases: 2024-11 · check-in free text available
2022-10-30
Report sent to call center — day 14, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-31
Call 3 — Left Voicemail
2022-11-06
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-13
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-20
Survey response — day 35, dose 4
MedDRA: Laryngitis, Sinus congestion — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sinus congestion and karyngiy

MedDRA releases: 2024-11 · check-in free text available
2022-11-20
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-11-21
Call 3 — Left Voicemail
2022-11-27
Survey response — day 42, dose 4
MedDRA: Dysphagia, Oropharyngeal pain, Respiratory tract congestion, Rhinitis, Self-medication, Sinusitis — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: My sinusitis and rhinitis is still causing congestion despite saline irrigation and prescribed nasal sprays. Swallowing and throat problems.

MedDRA releases: 2024-11 · check-in free text available
2022-11-27
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-11-28
Call X — Left Voicemail
2022-11-28
Call X — Left Voicemail
2022-11-28
Call X — Left Voicemail
2022-11-28
Call X — Left Voicemail
2022-11-28
Call X — Left Voicemail
2022-11-28
Call X — Left Voicemail
2022-11-28
Call 3 — Left Voicemail
2023-01-15
Survey response — 3 months, dose 4
MedDRA: Computerised tomogram abnormal, Dyspnoea, Nasal obstruction, Nasal valve collapse, Office visit, Sinus disorder — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-01-15
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-01-16
Call 1 — Left Voicemail
2023-01-16
Call 1 — Left Voicemail
2023-01-16
Call 1 — Left Voicemail
2023-01-16
Call 1 — Left Voicemail
2023-01-16
Call 1 — Left Voicemail
2023-01-16
Call 1 — Left Voicemail
2023-01-16
Call 1 — Left Voicemail
2023-01-16
Call 1 — Left Voicemail
2023-01-16
Call 1 — Left Voicemail
2023-04-18
Survey response — 6 months, dose 4
MedDRA: Dysphagia, Dyspnoea, Gastrooesophageal reflux disease, Nasal valve collapse, Oesophageal disorder, Sinusitis — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-18
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-19
Call 2 — Left Voicemail
2023-04-19
Call 2 — Left Voicemail
2023-04-19
Call 2 — Left Voicemail
2023-04-19
Call 2 — Left Voicemail
2023-04-19
Call 2 — Left Voicemail
2023-04-19
Call 2 — Left Voicemail
2023-04-19
Call 2 — Left Voicemail
2023-04-19
Call 2 — Left Voicemail
2023-04-19
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-17	Pfizer-BioNTech
2	2021-03-10	Pfizer-BioNTech
3	2021-08-28	Pfizer-BioNTech	Flu
4	2022-10-16	Pfizer-BioNTech	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-06-09	Unsuccessful
2021-09-08	Unsuccessful
2021-11-27	Unsuccessful
2022-08-28	Unsuccessful
2022-10-19	Unsuccessful
2022-10-30	Unsuccessful
2022-11-20	Unsuccessful
2022-11-27	Unsuccessful
2023-01-15	Unsuccessful
2023-04-18	Unsuccessful

Free text

Release 5 — day 14, dose 1

2021-03-03

Symptoms: dermatitis type flare up Itchy backTreated with special cream

Release 5 — days 1–6 daily, dose 2

2021-03-15

Systemic reaction (other): nasal congestion

2021-03-16

Systemic reaction (other): arthritic left wrist flared up past week

Release 5 — day 7, dose 2

2021-03-17

Systemic reaction (other): chills intermittently comes and goes

Release 6 — day 14, dose 2

2021-03-24

Symptoms: nasal congestion and dry cough

Release 6 — day 21, dose 2

2021-03-31

Symptoms: Seasonal allergies...mild

Release 9 — 3 months, dose 2

2021-06-09

Symptoms: Seasonal allergies, oab

Healthcare visit (other): primary care office visit and lab tests

Release 9 — 6 months, dose 2

2021-09-08

Symptoms: OAB and a UTIunder care of a urogynecologist

Healthcare visit (other): My primary care doctor referred me to urogynecologist. on 28th of August I got my Pfeizer booster and senior high dose flu shot and had no side effects

Release 10 — 3 months, dose 3

2021-11-27

Symptoms: Nasal congestion, scratchy throat; 6 month mark 11/22 for my series of 3 Synvisc knee shots

Release 12 — 12 months, dose 3

2022-08-28

Symptoms: Sinusitis and ear nose throat issues causing asthmatic symptoms. . Under doctor's care and on medications (no fever and test negative for C19)

Healthcare visit (other): Medical exam PCPdoctor and

Release 12 — day 0, dose 4

2022-10-16

Systemic reaction (other): nasal congestion

Release 12 — days 1–6 daily, dose 4

2022-10-17

Systemic reaction (other): Lingering nadal congestion from seasonal allergies

2022-10-18

Systemic reaction (other): As of 11/30/22 i will be considered a 5 year breast cancer survivor! I also have had MVR heart condition for8 years that I am monitored, tested, examined every 6 months. I get euflexxa shots both knees every 6 months for arthritis & meniscus. tears cut off by CDC

2022-10-19

Systemic reaction (other): perennial rhinitis, nasal congestion, voice box laryngitis

Healthcare visit (other): under current care ENT specialist with prescription nasal spray regimen and saline and continuing

2022-10-20

Systemic reaction (other): Tolerated both flu and bivalent! In August i had Prevnar 20 shot. i cutrently have a sinusitis/rhinitis flare up

2022-10-22

Systemic reaction (other): daily regimen for perennial rhinitis/sinusitis ordered by ENT doctor but unrelated to bivalent, flu or Prevnar shots. Taking daily 1-2 mile slow walks getting 5k to 6k steps therfore doing fine!

Release 12 — day 14, dose 4

2022-10-30

Symptoms: O A B. UTI . on antibiotics

Release 12 — day 35, dose 4

2022-11-20

Symptoms: Sinus congestion and karyngiy

Release 12 — day 42, dose 4

2022-11-27

Symptoms: My sinusitis and rhinitis is still causing congestion despite saline irrigation and prescribed nasal sprays. Swallowing and throat problems.

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	✓	✓	✓
HCVO	Unevaluable event	·	·	✓
SD	Asthma	·	·	✓
SD	Computerised tomogram abnormal	·	·	✓
SD	Cough	✓	✓	✓
SD	Dermatitis atopic	✓	✓	✓
SD	Dysphagia	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Ear, nose and throat disorder	·	·	✓
SD	Gastrooesophageal reflux disease	·	·	✓
SD	Hypersensitivity	✓	✓	✓
SD	Hypertonic bladder	·	·	✓
SD	Laryngitis	·	·	✓
SD	Nasal congestion	✓	✓	✓
SD	Nasal obstruction	·	·	✓
SD	Nasal valve collapse	·	·	✓
SD	Oesophageal disorder	·	·	✓
SD	Office visit	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinitis	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Seasonal allergy	✓	✓	✓
SD	Self-medication	·	·	✓
SD	Sinus congestion	·	·	✓
SD	Sinus disorder	·	·	✓
SD	Sinusitis	·	·	✓
SD	Throat irritation	·	·	✓
SD	Urinary tract infection	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Arthritis	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Laryngitis	·	·	✓
SRO	Nasal congestion	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rhinitis	·	·	✓
SRO	Rhinitis allergic	·	·	✓
SRO	Sinusitis	·	·	✓

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