Z5Y-27092-59820

2 vaccinations 6 coded responses 11 check-ins 6 free-text entries 6 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 117 / NY
Registered: 2021-04-07

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

2021-03-16
Dose 1 — Pfizer-BioNTech
2021-04-06
Dose 2 — Pfizer-BioNTech
2021-04-07
Registered in v-safe
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-04-10
Survey response — days 1–6 daily, dose 2
MedDRA: Rash, Self-medication — Feeling: Poor · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site · 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: Severe rash and taking Benadryl around the clock as advised by my physician

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Report sent to call center — days 1–6 daily, 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)
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site · 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

Adult check-in
2021-04-11
Report sent to call center — days 1–6 daily, 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)
2021-04-13
Survey response — day 7, dose 2
MedDRA: Dizziness — Feeling: Fair · Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-18
Survey response — day 42, dose 2
MedDRA: Confusional state, Diarrhoea, Dizziness, Rash — Feeling: Poor · 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, Emergency room or emergency department visit, Hospitalization

Free text: Diarrhea, rash, possible seizure activity, confusion, dizziness, occurred after the second vaccination and again one month later from the second vaccination.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Report sent to call center — day 42, 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)
2021-07-06
Survey response — 3 months, dose 2
MedDRA: Dizziness, Gastrointestinal disorder, Hypersensitivity, Stomatitis, Swollen tongue — 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, Emergency room or emergency department visit, Hospitalization

Free text: Dizziness that interferes with most daily activities, mouth sores, enlarged tongue, allergic reactions, gastrointestinal distress.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-06
Report sent to call center — 3 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-08
Call 1 — Left Voicemail
2021-10-05
Survey response — 6 months, dose 2
MedDRA: Mast cell activation syndrome, Office visit — 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

Free text: Doctors believe I developed. Mast Cell Activation #Syndrome from the vacccine

MedDRA releases: 2024-11 · check-in free text available
2021-10-05
Report sent to call center — 6 months, dose 2
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 · 1 call case(s)
2021-10-06
Call successful
Participant prefers to complete VAERS report online
2022-04-06
Survey response — 12 months, dose 2
MedDRA: Immunisation reaction, Mast cell activation syndrome — 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: I have developed mast cell activation syndrome since having a severe systemic reaction after my second Pfizer dose.

MedDRA releases: 2024-11 · check-in free text available
2022-04-06
Report sent to call center — 12 months, dose 2
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)
2022-04-07
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-16	Pfizer-BioNTech
2	2021-04-06	Pfizer-BioNTech

Call center

Reported	Outcome	VAERS-related outcome
2021-04-10	Successful	Participant prefers to complete VAERS report online
2021-04-11	Successful	Participant prefers to complete VAERS report online
2021-05-18	Successful	Participant prefers to complete VAERS report online
2021-07-06	Successful	Participant prefers to complete VAERS report online
2021-10-05	Successful 2021-10-06	Participant prefers to complete VAERS report online
2022-04-06	Successful 2022-04-07	Does not wish to fill out VAERS report

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-10

Systemic reaction (other): Severe rash and taking Benadryl around the clock as advised by my physician

Release 7 — day 7, dose 2

2021-04-13

Systemic reaction (other): Dizziness

Release 8 — day 42, dose 2

2021-05-18

Symptoms: Diarrhea, rash, possible seizure activity, confusion, dizziness, occurred after the second vaccination and again one month later from the second vaccination.

Release 9 — 3 months, dose 2

2021-07-06

Symptoms: Dizziness that interferes with most daily activities, mouth sores, enlarged tongue, allergic reactions, gastrointestinal distress.

Release 10 — 6 months, dose 2

2021-10-05

Symptoms: Doctors believe I developed. Mast Cell Activation #Syndrome from the vacccine

Release 11 — 12 months, dose 2

2022-04-06

Symptoms: I have developed mast cell activation syndrome since having a severe systemic reaction after my second Pfizer dose.

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	Confusional state	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Immunisation reaction	·	·	✓
SD	Mast cell activation syndrome	·	·	✓
SD	Office visit	·	·	✓
SD	Rash	✓	✓	✓
SD	Stomatitis	✓	✓	✓
SD	Swollen tongue	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Self-medication	✓	✓	✓

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