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Z5F-32464-13803

3 vaccinations 9 coded responses 35 check-ins 9 free-text entries 3 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
606 / IL
Registered
2020-12-30
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2020-12-29
    Dose 1 — Pfizer-BioNTech
  2. 2020-12-30
    Registered in v-safe
  3. 2020-12-30
    Survey response — days 1–6 daily, dose 1
    MedDRA: Migraine, Self-medication — Feeling: Good · Headache
    Free text: Mod Migraine - no response to Tylenol but did respond to fioricet
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2020-12-31
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  5. 2021-01-01
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-01-02
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  7. 2021-01-03
    Survey response — days 1–6 daily, dose 1
    MedDRA: Skin laceration — Feeling: Good · Fatigue or tiredness
    Free text: Healing leg laceration sustained 12/19/20
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-01-04
    Survey response — days 1–6 daily, dose 1
    MedDRA: Skin laceration — Feeling: Good · Fatigue or tiredness
    Free text: Traumatic healing leg laceration 12/19/20
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-01-06
    Survey response — day 7, dose 1
    MedDRA: Impaired healing, Limb injury — Feeling: Good · Fatigue or tiredness · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Systemic reaction (other): Still being treated for slowly healing traumatic leg wound · Healthcare visit (other): Not COVID vaccine related but due to leg injury stated above
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-01-06
    Report sent to call center — day 7, dose 1
    Get care from a doctor or other healthcare professional
    1 call case(s)
  11. 2021-01-12
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-01-19
    Dose 2 — Pfizer-BioNTech
  13. 2021-01-19
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  14. 2021-01-20
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Headache, Fatigue or tiredness
    Adult check-in
  15. 2021-01-21
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  16. 2021-01-22
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  17. 2021-01-23
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  18. 2021-01-24
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  19. 2021-01-25
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  20. 2021-01-26
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  21. 2021-02-02
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-02-09
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-02-16
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-02-23
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-04-20
    Survey response — 3 months, dose 2
    MedDRA: Accident, Limb injury, Office visit, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit
    Free text: Symptoms: Leg wound secondary to accident which required sutures. · Healthcare visit (other): Sutures
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  26. 2021-04-20
    Report sent to call center — 3 months, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  27. 2021-06-08
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  28. 2021-07-20
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  29. 2021-09-25
    Dose 3 — Pfizer-BioNTech
  30. 2021-09-27
    Survey response — days 1–6 daily, dose 3
    MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness
    Free text: No
    MedDRA releases: 2024-11 · check-in free text available
  31. 2021-09-29
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  32. 2021-09-30
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  33. 2021-10-01
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  34. 2021-10-02
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  35. 2021-10-09
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  36. 2021-10-16
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  37. 2021-10-23
    Survey response — day 28, dose 3
    MedDRA: Gout, Pre-existing disease, Self-medication — Feeling: Good
    Free text: Flare up of gout affecting my fingers. However, this followed an unusual change in diet due to visiting family and eating sausage for two meals in one day.Now taking NSAIDS, vitamin C, more coffee and adhering to a low purine diet.
    MedDRA releases: 2024-11 · check-in free text available
  38. 2021-10-30
    Survey response — day 35, dose 3
    MedDRA: Arthritis, Pre-existing disease — Feeling: Good
    Free text: Arthritis in fingers and great toe c/w preceding h/o gout.
    MedDRA releases: 2024-11 · check-in free text available
  39. 2021-11-06
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  40. 2021-12-25
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  41. 2022-03-26
    Survey response — 6 months, dose 3
    MedDRA: Office visit, Polymyalgia rheumatica, Pre-existing disease — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Symptoms: Seronegative rheumatoid arthritis, probably polymyalgia rheumatica requiring daily corticosteroid therapy · Healthcare visit (other): Repeated clinic visits, Ct, X-ray and blood tests
    MedDRA releases: 2024-11 · check-in free text available
  42. 2022-03-26
    Report sent to call center — 6 months, dose 3
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  43. 2022-03-29
  44. 2022-03-30
    Call successful
    Participant prefers to complete VAERS report online
  45. 2022-09-25
    Health check-in — 12 months, dose 3
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12020-12-29Pfizer-BioNTech
22021-01-19Pfizer-BioNTech
32021-09-25Pfizer-BioNTech No

Call center

ReportedOutcomeVAERS-related outcome
2021-01-06 Successful Participant prefers to complete VAERS report online
2021-04-20 Successful
2021-06-08
 Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-03-26 Successful
2022-03-30
 Participant prefers to complete VAERS report online

Free text

Release 1 — days 1–6 daily, dose 1

2020-12-30

Systemic reaction (other): Mod Migraine - no response to Tylenol but did respond to fioricet

2021-01-03

Systemic reaction (other): Healing leg laceration sustained 12/19/20

2021-01-04

Systemic reaction (other): Traumatic healing leg laceration 12/19/20

Release 1 — day 7, dose 1

2021-01-06

Systemic reaction (other): Still being treated for slowly healing traumatic leg wound
Healthcare visit (other): Not COVID vaccine related but due to leg injury stated above

Release 7 — 3 months, dose 2

2021-04-20

Symptoms: Leg wound secondary to accident which required sutures.
Healthcare visit (other): Sutures

Release 9 — days 1–6 daily, dose 3

2021-09-27

Systemic reaction (other): No

Release 10 — day 28, dose 3

2021-10-23

Symptoms: Flare up of gout affecting my fingers. However, this followed an unusual change in diet due to visiting family and eating sausage for two meals in one day.Now taking NSAIDS, vitamin C, more coffee and adhering to a low purine diet.

Release 10 — day 35, dose 3

2021-10-30

Symptoms: Arthritis in fingers and great toe c/w preceding h/o gout.

Release 11 — 6 months, dose 3

2022-03-26

Symptoms: Seronegative rheumatoid arthritis, probably polymyalgia rheumatica requiring daily corticosteroid therapy
Healthcare visit (other): Repeated clinic visits, Ct, X-ray and blood tests

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

FieldPreferred term2021-092023-042024-11
HCVOLimb injury ✓ ✓ ✓
HCVOOffice visit ✓ · ✓
HCVOUnevaluable event ○ ✓ ○
SDAccident ✓ · ✓
SDArthritis · · ✓
SDGout · · ✓
SDLimb injury ✓ · ✓
SDPolymyalgia rheumatica · · ✓
SDPre-existing disease · · ✓
SDSelf-medication · · ✓
SDUnevaluable event ○ ✓ ○
SROImpaired healing ✓ ✓ ✓
SROLimb injury ✓ ✓ ✓
SROMigraine ✓ ✓ ✓
SRONo adverse event · · ✓
SROSelf-medication ✓ ✓ ✓
SROSkin laceration ✓ ✓ ✓

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

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