Z69-29547-10236

5 vaccinations 9 coded responses 66 check-ins 8 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 112 / NY
Registered: 2021-03-10

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-03-10
Registered in v-safe
2021-03-10
Dose 1 — Pfizer-BioNTech
2021-03-10
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Good · Headache, Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-03-13
Survey response — days 1–6 daily, dose 1
MedDRA: Body temperature normal — Feeling: Good · Headache

Free text: Last night my temperature went up to 100.3 but today it is normal.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-17
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-07
Dose 2 — Pfizer-BioNTech
2021-04-07
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-08
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Headache, Fatigue or tiredness

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Diarrhea

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Headache

Adult check-in
2021-04-14
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-04-21
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-28
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-05
Survey response — day 28, dose 2
MedDRA: Diarrhoea — Feeling: Good

Free text: Diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-19
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-07
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-06
Survey response — 6 months, dose 2
MedDRA: Headache, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Frequent excruciating headaches, more painful than before. · Healthcare visit (other): Dr visit scheduled for tomorrow, 10/7/2021.

MedDRA releases: 2024-11 · check-in free text available
2021-10-06
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-05
Call 1 — Left Voicemail
2021-11-05
Call successful
Completed over the phone
2021-12-21
Dose 3 — Pfizer-BioNTech
2021-12-21
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain, Swelling · None

Adult check-in
2021-12-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-12-23
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-24
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-12-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-12-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-12-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-12-28
Health check-in — day 7, dose 3
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains · Be unable to do your normal daily activities

Adult check-in
2022-01-04
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-01-11
Survey response — day 21, dose 3
MedDRA: Headache, Nausea, Office visit, Respiratory tract congestion, SARS-CoV-2 test, SARS-CoV-2 test negative — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Had very bad headaches, nausea and congestion for 2-3 days. Took COVID PCR test on 1/6/2022 - Negative results. · Healthcare visit (other): COVID testing site at (b)(6) Medical Center

MedDRA releases: 2024-11 · check-in free text available
2022-01-11
Report sent to call center — day 21, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-01-12
Call 1 — Could Not Reach Participant
2022-01-18
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2022-01-18
Call successful
Participant prefers to complete VAERS report online
2022-01-25
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-02-01
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-22
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-04
Dose 4 — Pfizer-BioNTech
2022-06-04
Health check-in — day 0, dose 4
Feeling: Good · Headache

Adult check-in
2022-06-05
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2022-06-06
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Itching · Headache, Fatigue or tiredness

Adult check-in
2022-06-07
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-06-08
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-06-09
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · None

Adult check-in
2022-06-10
Survey response — days 1–6 daily, dose 4
MedDRA: Peripheral swelling — Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness

Free text: Right foot swollen since Wednesday. Unusual and don't know why. Never expected foot swelling before.

MedDRA releases: 2024-11 · check-in free text available
2022-06-11
Health check-in — day 7, dose 4
Feeling: Good · Site: Swelling, Itching · Fatigue or tiredness

Adult check-in
2022-06-18
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-25
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-07-02
Survey response — day 28, dose 4
MedDRA: Headache, Nodule, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Sore knot on my head · Healthcare visit (other): Will call my doctor if it worsened

MedDRA releases: 2024-11 · check-in free text available
2022-07-02
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-07-05
Call successful
Does not wish to fill out VAERS report
2022-07-09
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-16
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-09-03
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-19
Dose 5 — Pfizer-BioNTech
2022-10-19
Health check-in — day 0, dose 5
Feeling: Good · None

Adult check-in
2022-10-20
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Headache

Adult check-in
2022-10-21
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-22
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Itching · None

Adult check-in
2022-10-23
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2022-10-24
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-25
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-26
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2022-11-02
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-11-09
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-16
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-23
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-30
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-18
Survey response — 3 months, dose 5
MedDRA: Gastroenteritis viral, Office visit, SARS-CoV-2 test negative — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-01-18
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

1 call case(s)
2023-01-19
Call 1 — Requested Callback
2023-01-19
Callback requested for
10:00AM ET
2023-01-19
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-10	Pfizer-BioNTech
2	2021-04-07	Pfizer-BioNTech
3	2021-12-21	Pfizer-BioNTech	No
4	2022-06-04	Pfizer-BioNTech	No
5	2022-10-19	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-10-06	Successful 2021-11-05	Completed over the phone
2022-01-11	Successful 2022-01-18	Participant prefers to complete VAERS report online
2022-07-02	Successful 2022-07-05	Does not wish to fill out VAERS report
2023-01-18	Successful 2023-01-19	Participant prefers to complete VAERS report online

Free text

Release 5 — day 0, dose 1

2021-03-10

Systemic reaction (other): No

Release 5 — days 1–6 daily, dose 1

2021-03-13

Systemic reaction (other): Last night my temperature went up to 100.3 but today it is normal.

Release 7 — days 1–6 daily, dose 2

2021-04-08

Systemic reaction (other): No

Release 8 — day 28, dose 2

2021-05-05

Symptoms: Diarrhea

Release 10 — 6 months, dose 2

2021-10-06

Symptoms: Frequent excruciating headaches, more painful than before.

Healthcare visit (other): Dr visit scheduled for tomorrow, 10/7/2021.

Release 10 — day 21, dose 3

2022-01-11

Symptoms: Had very bad headaches, nausea and congestion for 2-3 days. Took COVID PCR test on 1/6/2022 - Negative results.

Healthcare visit (other): COVID testing site at (b)(6) Medical Center

redacted (b)(6)

Release 12 — days 1–6 daily, dose 4

2022-06-10

Systemic reaction (other): Right foot swollen since Wednesday. Unusual and don't know why. Never expected foot swelling before.

Release 12 — day 28, dose 4

2022-07-02

Symptoms: Sore knot on my head

Healthcare visit (other): Will call my doctor if it worsened

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	Office visit	·	·	✓
HCVO	SARS-CoV-2 test	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Gastroenteritis viral	·	·	✓
SD	Headache	·	·	✓
SD	Nausea	·	·	✓
SD	Nodule	·	·	✓
SD	Office visit	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Body temperature normal	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Peripheral swelling	·	·	✓

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