Z5G-54091-98568

5 vaccinations 7 coded responses 23 check-ins 7 free-text entries 6 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 917 / CA
Registered: 2021-01-02

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2020-12-22
Dose 1 — Pfizer-BioNTech
2021-01-02
Registered in v-safe
2021-01-02
Health check-in — day 7, dose 1
Feeling: Fair · Chills, Rash, not including the immediate area around the injection site

Adult check-in
2021-01-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-12
Dose 2 — Pfizer-BioNTech
2021-01-12
Health check-in — day 0, dose 2
Feeling: Poor · Site: Pain, Itching · Headache, Muscle or body aches, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-12
Report sent to call center — day 0, dose 2
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Joint pains, Muscle or body aches

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Muscle or body aches

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-01-26
Survey response — day 14, dose 2
MedDRA: Back pain, Pain in extremity — Feeling: Fair · Be unable to work, 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: Back pain- thoracic area- with excrutiating pain in my left thigh bone. I couldn't walk.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Report sent to call center — day 14, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-03
Survey response — day 21, dose 2
MedDRA: Neuralgia, Pain in extremity, Physiotherapy — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Severe nerve pain in my left leg. I don't believe it's related. · Healthcare visit (other): X rays and physical therapy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-02-23
Survey response — day 42, dose 2
MedDRA: Glossodynia — Feeling: Good

Free text: A sore on my tongue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — 3 months, dose 2
MedDRA: Eczema, Hypersensitivity — Feeling: Good

Free text: An allergic reaction to the metal on my Timex wristwatch. I've always worn the same watch, 24/7, without incident until last week. Horrible eczema which I've never had before.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-07
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-07-13
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-07-31
Dose 3 — Moderna
2022-01-12
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-02-01
Dose 4 — Moderna
2022-06-04
Dose 5 — Moderna
2022-06-07
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-27
Survey response — day 21, dose 5
MedDRA: Bronchitis — Feeling: Fair · Be unable to work or attend school, 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: Bronchitis

MedDRA releases: 2024-11 · check-in free text available
2022-06-27
Report sent to call center — day 21, dose 5
Be unable to work or attend school · 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)
2022-06-28
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-02
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-07-09
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-07-18
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2022-09-03
Survey response — 3 months, dose 5
MedDRA: Pre-existing disease, Sciatica — 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: Sciatica flare up. Unrelated to the vaccine.

MedDRA releases: 2024-11 · check-in free text available
2022-09-03
Report sent to call center — 3 months, dose 5
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)
2022-09-06
Call 1 — Left Voicemail
2022-09-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-03
Survey response — 6 months, dose 5
MedDRA: Condition aggravated, Hospitalisation, 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 · Emergency room or emergency department visit, Hospitalization

Free text: Severe radiculopathy. Hospitalized 5 days. (Chronic condition with a severe flare up).

MedDRA releases: 2024-11 · check-in free text available
2022-12-03
Report sent to call center — 6 months, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-12-05
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-22	Pfizer-BioNTech
2	2021-01-12	Pfizer-BioNTech
3	2021-07-31	Moderna	No
4	2022-02-01	Moderna	No
5	2022-06-04	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-12	priority 2/3
2021-01-26	Successful 2022-06-07	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-02-03	Successful 2021-06-07	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-27	Successful 2022-06-28	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-09-03	Successful 2022-09-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-03	Unsuccessful

Free text

Release 2 — day 14, dose 2

2021-01-26

Symptoms: Back pain- thoracic area- with excrutiating pain in my left thigh bone. I couldn't walk.

Release 3 — day 21, dose 2

2021-02-03

Symptoms: Severe nerve pain in my left leg. I don't believe it's related.

Healthcare visit (other): X rays and physical therapy

Release 4 — day 42, dose 2

2021-02-23

Symptoms: A sore on my tongue

Release 7 — 3 months, dose 2

2021-04-13

Symptoms: An allergic reaction to the metal on my Timex wristwatch. I've always worn the same watch, 24/7, without incident until last week. Horrible eczema which I've never had before.

Release 12 — day 21, dose 5

2022-06-27

Symptoms: Bronchitis

Release 12 — 3 months, dose 5

2022-09-03

Symptoms: Sciatica flare up. Unrelated to the vaccine.

Release 12 — 6 months, dose 5

2022-12-03

Symptoms: Severe radiculopathy. Hospitalized 5 days. (Chronic condition with a severe flare up).

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	Physiotherapy	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Bronchitis	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Eczema	✓	✓	✓
SD	Glossodynia	✓	✓	✓
SD	Hospitalisation	·	·	✓
SD	Hypersensitivity	✓	✓	✓
SD	Neuralgia	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Sciatica	·	·	✓

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