Z5H-17096-85016

4 vaccinations 7 coded responses 27 check-ins 7 free-text entries 7 call cases

Sex: Female
Age at first dose: 26-30
ZIP prefix: 999 / AK
Registered: 2021-01-07

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

2021-01-07
Registered in v-safe
2021-01-08
Dose 1 — Pfizer-BioNTech
2021-01-08
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-01-09
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-10
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-27
Dose 2 — Pfizer-BioNTech
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-31
Survey response — days 1–6 daily, dose 2
MedDRA: Herpes simplex, Paraesthesia, Pre-existing disease — Feeling: Good

Free text: Herpes virus 1 outbreak. Had 1 about 5 days after the 1st vaccine. Feel the tingly sensation now.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Survey response — days 1–6 daily, dose 2
MedDRA: Herpes simplex, Oral disorder — Feeling: Good

Free text: HSV 1 oral lesion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-17
Survey response — day 21, dose 2
MedDRA: Condition aggravated, Herpes simplex, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: HSV 1 outbreak on face again! This is the 3rd. Dont love that.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-24
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-03
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-30
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-05-31
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2021-07-28
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-09-29
Dose 3 — Pfizer-BioNTech
2022-01-27
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-03-21
Dose 4 — Moderna
2022-04-19
Survey response — day 28, dose 4
MedDRA: Herpes simplex — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: HSV 1 outbreak

MedDRA releases: 2024-11 · check-in free text available
2022-04-19
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-20
Call 1 — Could Not Reach Participant
2022-04-25
Survey response — day 35, dose 4
MedDRA: Herpes simplex — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Hsv outbreak not improving with acyclovir

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-25
Call successful
Does not wish to fill out VAERS report
2022-05-02
Survey response — day 42, dose 4
MedDRA: Fall, Sepsis, Skin laceration — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Totally unrelated to my covid vaccine. I fell and got a tiny cut that turned into sepsis, so that's fun.

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Report sent to call center — day 42, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-20
Survey response — 3 months, dose 4
MedDRA: Herpes simplex, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I'm now taking acyclovir everyday to prevent herpes simplex type 1 outbreaks on my face because I had so many outbreaks on a row.

MedDRA releases: 2024-11 · check-in free text available
2022-06-20
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)
2022-06-21
Call 1 — Left Voicemail
2023-03-21
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-08	Pfizer-BioNTech
2	2021-01-27	Pfizer-BioNTech
3	2021-09-29	Pfizer-BioNTech	No
4	2022-03-21	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-09	priority 2/3
2021-01-10	priority 2/3
2021-02-17	Successful 2021-05-31	Reported to VAERS voluntarily prior to GDIT contact
2022-04-19	Successful 2022-04-25	Does not wish to fill out VAERS report
2022-04-25	Successful	Does not wish to fill out VAERS report
2022-05-02	Successful 2022-05-03	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-20	Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 2

2021-01-31

Systemic reaction (other): Herpes virus 1 outbreak. Had 1 about 5 days after the 1st vaccine. Feel the tingly sensation now.

2021-02-02

Systemic reaction (other): HSV 1 oral lesion

Release 4 — day 21, dose 2

2021-02-17

Symptoms: HSV 1 outbreak on face again! This is the 3rd. Dont love that.

Release 11 — day 28, dose 4

2022-04-19

Symptoms: HSV 1 outbreak

Release 11 — day 35, dose 4

2022-04-25

Symptoms: Hsv outbreak not improving with acyclovir

Release 11 — day 42, dose 4

2022-05-02

Symptoms: Totally unrelated to my covid vaccine. I fell and got a tiny cut that turned into sepsis, so that's fun.

Release 12 — 3 months, dose 4

2022-06-20

Symptoms: I'm now taking acyclovir everyday to prevent herpes simplex type 1 outbreaks on my face because I had so many outbreaks on a row.

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	Condition aggravated	✓	✓	✓
SD	Fall	·	·	✓
SD	Herpes simplex	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Sepsis	·	·	✓
SD	Skin laceration	·	·	✓
SRO	Herpes simplex	✓	✓	✓
SRO	Oral disorder	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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