Z4J-29266-13944

3 vaccinations 6 coded responses 6 check-ins 6 free-text entries 5 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 028 / RI
Registered: 2021-02-22

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

2021-02-22
Registered in v-safe
2021-02-22
Dose 1 — Pfizer-BioNTech
2021-03-15
Dose 2 — Pfizer-BioNTech
2021-06-14
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Fatigue, Oral discomfort, Pyrexia — Feeling: Fair · 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: Burning mouth Joint pain fatigue fever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-14
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-23
Call 1 — Left Voicemail
2021-08-21
Dose 3 — Pfizer-BioNTech
2021-09-13
Survey response — 6 months, dose 2
MedDRA: Colitis ulcerative, Hospitalisation, Pre-existing disease — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Hospitalized with severe flare of Ulcerative colitis- 4 days after getting 3rd shot at direction of 3 of my specialists

MedDRA releases: 2024-11 · check-in free text available
2021-09-13
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-09-14
Call successful
Participant prefers to complete VAERS report online
2021-10-02
Survey response — day 42, dose 3
MedDRA: Colitis ulcerative, Diarrhoea, Headache, Pain, Pre-existing disease, Pyrexia, Rectal haemorrhage, Vomiting — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Flare of Ulcerative Colitis-pain,diarrhea, rectal bleeding, vomitting, fever, headache

MedDRA releases: 2024-11 · check-in free text available
2021-10-02
Report sent to call center — day 42, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-11-20
Survey response — 3 months, dose 3
MedDRA: Colitis ulcerative, Hospitalisation, Pre-existing disease — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Cushings From high dose steroids given to help the flare that began 4 days after booster/3rd COVID shot Still getting evaluated & treated for UC flare after week hospital stay that ended 9/2/21

MedDRA releases: 2024-11 · check-in free text available
2022-02-19
Survey response — 6 months, dose 3
MedDRA: Colitis ulcerative, Hospitalisation, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization

Free text: UC flarestarted 8/25 - hospitalized for 1 week - have not gotten better - dx w/Cushings from prednisone-admitted again 2/15 - symptoms have not improved over months - stopped Humira - began Stelara 1/19 - no one is sure related to COVID vax

MedDRA releases: 2024-11 · check-in free text available
2022-02-19
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-02-21
Call 1 — Left Voicemail
2022-08-21
Survey response — 12 months, dose 3
MedDRA: Burning mouth syndrome, Colitis ulcerative, Headache, Muscle spasms, Pain, Pre-existing disease, Rheumatoid arthritis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Continued symptoms of auto immune flare UC & RA - increased pain/headaches/muscle spasms Burning mouth syndrome is bad everyday

MedDRA releases: 2024-11 · check-in free text available
2022-08-21
Report sent to call center — 12 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-08-22
Call 2 — Left Voicemail
2022-08-22
Call 1 — Left Voicemail
2022-08-22
Call 1 — Left Voicemail
2022-08-22
Call 2 — Left Voicemail
2022-08-22
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-22	Pfizer-BioNTech
2	2021-03-15	Pfizer-BioNTech
3	2021-08-21	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-06-14	Successful	Participant prefers to complete VAERS report online
2021-09-13	Successful 2021-09-14	Participant prefers to complete VAERS report online
2021-10-02	Successful	Participant prefers to complete VAERS report online
2022-02-19	Unsuccessful
2022-08-21	Unsuccessful

Free text

Release 9 — 3 months, dose 2

2021-06-14

Symptoms: Burning mouth Joint pain fatigue fever

Release 9 — 6 months, dose 2

2021-09-13

Symptoms: Hospitalized with severe flare of Ulcerative colitis- 4 days after getting 3rd shot at direction of 3 of my specialists

Release 9 — day 42, dose 3

2021-10-02

Symptoms: Flare of Ulcerative Colitis-pain,diarrhea, rectal bleeding, vomitting, fever, headache

Release 10 — 3 months, dose 3

2021-11-20

Symptoms: Cushings From high dose steroids given to help the flare that began 4 days after booster/3rd COVID shot Still getting evaluated & treated for UC flare after week hospital stay that ended 9/2/21

Release 11 — 6 months, dose 3

2022-02-19

Symptoms: UC flarestarted 8/25 - hospitalized for 1 week - have not gotten better - dx w/Cushings from prednisone-admitted again 2/15 - symptoms have not improved over months - stopped Humira - began Stelara 1/19 - no one is sure related to COVID vax

Release 12 — 12 months, dose 3

2022-08-21

Symptoms: Continued symptoms of auto immune flare UC & RA - increased pain/headaches/muscle spasms Burning mouth syndrome is bad everyday

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	Arthralgia	✓	✓	✓
SD	Burning mouth syndrome	·	·	✓
SD	Colitis ulcerative	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Oral discomfort	✓	✓	✓
SD	Pain	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Rectal haemorrhage	·	·	✓
SD	Rheumatoid arthritis	·	·	✓
SD	Vomiting	·	·	✓

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