Z5V-23264-96057

5 vaccinations 14 coded responses 17 check-ins 14 free-text entries 7 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 600 / IL
Registered: 2021-02-24

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

2021-02-01
Dose 1 — Pfizer-BioNTech
2021-02-19
Dose 2 — Pfizer-BioNTech
2021-02-24
Registered in v-safe
2021-02-24
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: CVID patient, lung disease and Acute febrile neutrophilic dermatosis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-02-26
Survey response — day 7, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Rash, not including the immediate area around the injection site

Free text: CVID, lung disease (previous VATS procedure to remove half a lung) and sweets syndrome

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — day 14, dose 2
MedDRA: Pre-existing disease, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: A fairly bad RASH every single day since my second vaccine that comes and goes.But Im also chronically ill with CVID and lung disease and sweets syndrome. I set up a telehealth for Tuesday regarding this issue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-12
Survey response — day 21, dose 2
MedDRA: Rash, Telemedicine — 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: Symptoms: Severe rash full blown sweets syndrome rash ever since my second Pfizer vaccine. It got real bad. But Im high risk for COVID so I didnt want to discourage anyone from a vaccine because I NEED everyone vaccinated! · Healthcare visit (other): Telehealth in isolation not allowed around COVID germs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
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)
2021-03-19
Survey response — day 28, dose 2
MedDRA: Rash, Telemedicine — 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: Symptoms: A RASH that seems to be lasting a LIFETIME since the vaccine. I think maybe I am allergic to that Pfizer vaccine and might need the Moderna vaccine. · Healthcare visit (other): High risk patient so Im only allowed to have Telehealths

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-26
Survey response — day 35, dose 2
MedDRA: Medical counselling, Pre-existing disease, Rash — 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: Symptoms: Bad rash that still continues to last a lifetime apparently after the Pfizer vaccine. High risk 36 old patient with multiple medical conditions. CVID interstitial lung disease and half a lung. · Healthcare visit (other): Isolation for 13 months so all my visits are Telehealth besides my PORT treatments in person

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-03
Survey response — day 42, dose 2
MedDRA: Rash, Telemedicine — 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: Symptoms: Never ending RASH that blew up even WORSE again. · Healthcare visit (other): High risk patient only allowed to do telehealths

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-21
Survey response — 3 months, dose 2
MedDRA: Fatigue, Medical observation, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Yep. I landed myself back in the cancer center for PORT Injectefor the past 2 weeks. Also, Im very exhausted and I am IMMUNOCOMPROMISED so I have GAMMAGARD tomorrow. I also have to stay inside because the CDC got rid of masks for healthy people. · Healthcare visit (other): Cancer Center Treatment Department

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
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)
2021-06-14
Call 1 — Left Voicemail
2021-08-16
Dose 3 — Pfizer-BioNTech
2021-08-20
Survey response — 6 months, dose 2
MedDRA: Immunisation reaction, Immunodeficiency — Feeling: Fair · Be unable to do your normal daily activities

Free text: COVID-arm.From my Immunocompromised 3rd Pfizer vaccine regimen. But I never had COVID arm with the first 2 Pfizer vaccines. ONLY with the third vaccine. So maybe the 3rd time is the LUCKY charm for the Immunocompromised!

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-02-19
Survey response — 12 months, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: I got my 2 IMMUNOCOMPROMISED EVUSHELD vaccines on 2/16/2022.

MedDRA releases: 2024-11 · check-in free text available
2022-02-19
Survey response — 6 months, dose 3
MedDRA: Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: I got my 2 immunocompromised EVUSHELD vaccines on 2/16/2022.

MedDRA releases: 2024-11 · check-in free text available
2022-04-06
Dose 4 — Pfizer-BioNTech
2022-08-18
Survey response — 12 months, dose 3
MedDRA: Fall, Rotator cuff repair, Rotator cuff syndrome — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Fell down stairs FULL width and FULL thickness tear of the supraspanatis rotar cuff. Had surgery on August 10, 2022

MedDRA releases: 2024-11 · check-in free text available
2022-09-09
Dose 5 — Pfizer-BioNTech
2022-10-15
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2022-10-21
Survey response — day 42, dose 5
MedDRA: Respiratory syncytial virus infection — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: RSV

MedDRA releases: 2024-11 · check-in free text available
2022-12-09
Survey response — 3 months, dose 5
MedDRA: Pneumonia, Respiratory syncytial virus infection — Feeling: Fair · 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

Free text: RSV and PNEUMONIA

MedDRA releases: 2024-11 · check-in free text available
2022-12-09
Report sent to call center — 3 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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-12-12
Call 1 — Left Voicemail
2023-03-13
Health check-in — 6 months, dose 5
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-01	Pfizer-BioNTech
2	2021-02-19	Pfizer-BioNTech
3	2021-08-16	Pfizer-BioNTech	No
4	2022-04-06	Pfizer-BioNTech	No
5	2022-09-09	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-05	Successful	Participant prefers to complete VAERS report online
2021-03-12	Successful	Participant prefers to complete VAERS report online
2021-03-19	Successful	Participant prefers to complete VAERS report online
2021-03-26	Successful	Participant prefers to complete VAERS report online
2021-04-03	Successful	Participant prefers to complete VAERS report online
2021-05-21	Successful	Participant prefers to complete VAERS report online
2022-12-09	Unsuccessful

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-24

Systemic reaction (other): CVID patient, lung disease and Acute febrile neutrophilic dermatosis

Release 4 — day 7, dose 2

2021-02-26

Systemic reaction (other): CVID, lung disease (previous VATS procedure to remove half a lung) and sweets syndrome

Release 5 — day 14, dose 2

2021-03-05

Symptoms: A fairly bad RASH every single day since my second vaccine that comes and goes.But Im also chronically ill with CVID and lung disease and sweets syndrome. I set up a telehealth for Tuesday regarding this issue.

Release 5 — day 21, dose 2

2021-03-12

Symptoms: Severe rash full blown sweets syndrome rash ever since my second Pfizer vaccine. It got real bad. But Im high risk for COVID so I didnt want to discourage anyone from a vaccine because I NEED everyone vaccinated!

Healthcare visit (other): Telehealth in isolation not allowed around COVID germs

Release 6 — day 28, dose 2

2021-03-19

Symptoms: A RASH that seems to be lasting a LIFETIME since the vaccine. I think maybe I am allergic to that Pfizer vaccine and might need the Moderna vaccine.

Healthcare visit (other): High risk patient so Im only allowed to have Telehealths

Release 6 — day 35, dose 2

2021-03-26

Symptoms: Bad rash that still continues to last a lifetime apparently after the Pfizer vaccine. High risk 36 old patient with multiple medical conditions. CVID interstitial lung disease and half a lung.

Healthcare visit (other): Isolation for 13 months so all my visits are Telehealth besides my PORT treatments in person

Release 6 — day 42, dose 2

2021-04-03

Symptoms: Never ending RASH that blew up even WORSE again.

Healthcare visit (other): High risk patient only allowed to do telehealths

Release 8 — 3 months, dose 2

2021-05-21

Symptoms: Yep. I landed myself back in the cancer center for PORT Injectefor the past 2 weeks. Also, Im very exhausted and I am IMMUNOCOMPROMISED so I have GAMMAGARD tomorrow. I also have to stay inside because the CDC got rid of masks for healthy people.

Healthcare visit (other): Cancer Center Treatment Department

Release 9 — 6 months, dose 2

2021-08-20

Symptoms: COVID-arm.From my Immunocompromised 3rd Pfizer vaccine regimen. But I never had COVID arm with the first 2 Pfizer vaccines. ONLY with the third vaccine. So maybe the 3rd time is the LUCKY charm for the Immunocompromised!

Release 11 — 12 months, dose 2

2022-02-19

Symptoms: I got my 2 IMMUNOCOMPROMISED EVUSHELD vaccines on 2/16/2022.

Release 11 — 6 months, dose 3

2022-02-19

Symptoms: I got my 2 immunocompromised EVUSHELD vaccines on 2/16/2022.

Release 12 — 12 months, dose 3

2022-08-18

Symptoms: Fell down stairs FULL width and FULL thickness tear of the supraspanatis rotar cuff. Had surgery on August 10, 2022

Release 12 — day 42, dose 5

2022-10-21

Symptoms: RSV

Release 12 — 3 months, dose 5

2022-12-09

Symptoms: RSV and PNEUMONIA

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	Medical counselling	✓	✓	✓
HCVO	Medical observation	✓	✓	✓
HCVO	Telemedicine	✓	✓	✓
SD	Fall	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Immunisation reaction	✓	·	✓
SD	Immunodeficiency	✓	·	✓
SD	Pneumonia	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Respiratory syncytial virus infection	·	·	✓
SD	Rotator cuff repair	·	·	✓
SD	Rotator cuff syndrome	·	·	✓
SRO	Pre-existing disease	✓	✓	✓

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