Z53-10630-12923
3 vaccinations
8 coded responses
37 check-ins
7 free-text entries
4 call cases
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 476 / IN
- Registered
- 2021-03-14
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-12
Dose 1 — Pfizer-BioNTech
-
2021-03-14
Registered in v-safe
- 2021-03-14
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-26
- 2021-04-02
-
2021-04-09
Dose 2 — Pfizer-BioNTech
- 2021-04-09
-
2021-04-10
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activitiesAdult check-in
- 2021-04-11
- 2021-04-12
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2021-04-13
Survey response — days 1–6 daily, dose 2MedDRA: Discomfort, Ear discomfort, Headache, Paranasal sinus discomfort — Feeling: Fair · Headache, Fatigue or tirednessFree text: I have had sinus pressure since the second day. My head hurts, pressure in my face and ear. Probably a sinus infection coming on and not related to the shot but my husband had the same symptoms after his first shot and had a severe sinus infection a few days laterMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-14
-
2021-04-15
Survey response — days 1–6 daily, dose 2MedDRA: Respiratory tract congestion — Feeling: Fair · Site: Pain · Headache, Fatigue or tirednessFree text: CongestedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-16
- 2021-04-23
- 2021-04-30
-
2021-05-07
Survey response — day 28, dose 2MedDRA: Dizziness, Ear discomfort, Eustachian tube obstruction, Malaise, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Went to the dr today with dizziness, pressure in ear and just not feeling good. Figured it was an ear infection, sinus infection or allergies. He said my Eustachian tube was clogged . I definitely dont think the vaccine had anything with t · Healthcare visit (other): Family Dr office visitMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-07
Report sent to call center — day 28, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-05-14
- 2021-05-21
- 2021-07-09
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2021-10-08
Survey response — 6 months, dose 2MedDRA: Alopecia, Alopecia scarring, Lichen planopilaris — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: I have been diagnosed with Frontal Fibrosing Alopecia. This is where u lose hair it is a scarring alopecia. It does not grow back. Probably not vaccine related but had symptoms same month as vaccine. Just didn't know I should be concerned at that timMedDRA releases: 2024-11 · check-in free text available
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2021-10-08
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2021-10-11
-
2021-10-11
Callback requested for07:00PM ET
-
2021-10-11
Call successfulParticipant prefers to complete VAERS report online
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2021-10-11
Call successfulParticipant prefers to complete VAERS report online
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2022-01-26
Dose 3 — Pfizer-BioNTech
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2022-01-26
Survey response — day 0, dose 3MedDRA: Lichen planopilaris, Rash — Feeling: GoodFree text: I was diagnosed with frontal fibrosing alopecia last summer. I had both vaccines around 4 months before diagnosing. I started getting little bumps in my frontal hairline. Probably not related to vaccine today before booster no issues presentMedDRA releases: 2024-11 · check-in free text available
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2022-01-27
Survey response — days 1–6 daily, dose 3MedDRA: Back pain, Pre-existing disease — Feeling: Fair · Site: Pain · Muscle or body achesFree text: Back pain,had before booster seems worse todayMedDRA releases: 2024-11 · check-in free text available
- 2022-01-28
- 2022-01-29
- 2022-01-31
- 2022-02-02
- 2022-02-09
- 2022-02-16
- 2022-02-23
- 2022-03-02
- 2022-03-09
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2022-04-27
Survey response — 3 months, dose 3MedDRA: COVID-19, Headache, Respiratory tract congestion, Sinusitis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: I was diagnosed yesterday with Covid. I have a headache and congestion. · Healthcare visit (other): I thought I had a sinus infection so I went hoping I'd get an antibioticMedDRA releases: 2024-11 · check-in free text available
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2022-04-27
Report sent to call center — 3 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-04-28
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-07-27
-
2023-01-28
Survey response — 12 months, dose 3MedDRA: Lichen planopilaris, Sleep disorder — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
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2023-01-28
Report sent to call center — 12 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2023-01-30
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-12 | Pfizer-BioNTech | |
| 2 | 2021-04-09 | Pfizer-BioNTech | |
| 3 | 2022-01-26 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-05-07 | Successful 2021-10-11 |
Participant prefers to complete VAERS report online |
| 2021-10-08 | Successful 2021-10-11 |
Participant prefers to complete VAERS report online |
| 2022-04-27 | Successful 2022-04-28 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2023-01-28 | Successful 2023-01-30 |
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
Systemic reaction (other): I have had sinus pressure since the second day. My head hurts, pressure in my face and ear. Probably a sinus infection coming on and not related to the shot but my husband had the same symptoms after his first shot and had a severe sinus infection a few days later
Systemic reaction (other): Congested
Release 8 — day 28, dose 2
Symptoms: Went to the dr today with dizziness, pressure in ear and just not feeling good. Figured it was an ear infection, sinus infection or allergies. He said my Eustachian tube was clogged . I definitely dont think the vaccine had anything with t
Healthcare visit (other): Family Dr office visit
Release 10 — 6 months, dose 2
Symptoms: I have been diagnosed with Frontal Fibrosing Alopecia. This is where u lose hair it is a scarring alopecia. It does not grow back. Probably not vaccine related but had symptoms same month as vaccine. Just didn't know I should be concerned at that tim cut off by CDC
Release 11 — day 0, dose 3
Systemic reaction (other): I was diagnosed with frontal fibrosing alopecia last summer. I had both vaccines around 4 months before diagnosing. I started getting little bumps in my frontal hairline. Probably not related to vaccine today before booster no issues present
Release 11 — days 1–6 daily, dose 3
Systemic reaction (other): Back pain,had before booster seems worse today
Release 11 — 3 months, dose 3
Symptoms: I was diagnosed yesterday with Covid. I have a headache and congestion.
Healthcare visit (other): I thought I had a sinus infection so I went hoping I'd get an antibiotic
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 | Sinusitis | · | · | ✓ |
| SD | Alopecia | · | · | ✓ |
| SD | Alopecia scarring | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Dizziness | ✓ | ✓ | ✓ |
| SD | Ear discomfort | ✓ | ✓ | ✓ |
| SD | Eustachian tube obstruction | ✓ | ✓ | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Lichen planopilaris | · | · | ✓ |
| SD | Malaise | ✓ | ✓ | ✓ |
| SD | Office visit | ✓ | ✓ | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Sleep disorder | · | · | ✓ |
| SRO | Back pain | · | · | ✓ |
| SRO | Discomfort | ✓ | ✓ | ✓ |
| SRO | Ear discomfort | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Lichen planopilaris | · | · | ✓ |
| SRO | Paranasal sinus discomfort | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
| SRO | Rash | · | · | ✓ |
| SRO | Respiratory tract congestion | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release