Z6R-25839-69446

3 vaccinations 8 coded responses 18 check-ins 8 free-text entries 7 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 208 / MD
Registered: 2021-01-13

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

2021-01-10
Dose 1 — Pfizer-BioNTech
2021-01-13
Registered in v-safe
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · None

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

Adult check-in
2021-01-28
Dose 2 — Pfizer-BioNTech
2021-02-10
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Diarrhea

Adult check-in
2021-02-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-18
Survey response — day 21, dose 2
MedDRA: Diarrhoea, Self-medication — Feeling: Fair

Free text: Some diarrhea but have been taking a laxative

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — day 28, dose 2
MedDRA: Blood culture positive, Escherichia infection, Hospitalisation, SARS-CoV-2 test negative, Urosepsis — Feeling: Good · Be unable to work, 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: Developed urosepsis requiring short term hospitalization. Blood cultures demonstrated E Coli. Treated successfully with IV antibiotics. COVID test in hospital negative

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Report sent to call center — day 28, 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)
2021-03-11
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-02
Survey response — 6 months, dose 2
MedDRA: Bronchitis, Upper respiratory tract infection — 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: Developed Covid negative upper respiratory tract infection picked up from brother-in-law culminating in bronchitis. Lasted for over a week somewhat improved at present.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-02
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-28
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2021-09-30
Survey response — days 1–6 daily, dose 3
MedDRA: Cardiac failure congestive, Pneumonia — Feeling: Poor · Fever · Chills, Fatigue or tiredness, Abdominal pain · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Pneumonia and congestive heart failure

MedDRA releases: 2024-11 · check-in free text available
2021-09-30
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-10-02
Survey response — days 1–6 daily, dose 3
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Poor · Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Hospitalization

Free text: These symptoms are not caused by covid. I have a another pre-existing condition. However I believe that the two vaccines I received - the Pfizer booster and flu precipitated my pre-existing medical condition.

MedDRA releases: 2024-11 · check-in free text available
2021-10-02
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2021-10-03
Survey response — days 1–6 daily, dose 3
MedDRA: Pre-existing disease — Feeling: Fair · Site: Pain · Fatigue or tiredness, Abdominal pain · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: I believe my symptoms are not related to the receipt of the booster vaccine but I are rather the consequence of a pre-existing medical conditions

MedDRA releases: 2024-11 · check-in free text available
2021-10-03
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-10-04
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-06
Survey response — day 7, dose 3
MedDRA: Adverse reaction — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms unrelated to covid booster

MedDRA releases: 2024-11 · check-in free text available
2021-10-06
Report sent to call center — day 7, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-10-12
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-13
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-10-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-10-28
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-28
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-10-01
Survey response — 12 months, dose 3
MedDRA: Cardiac disorder, Catheterisation cardiac — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Cardiac problems requiring cardiac catheterization unassociated with covid

MedDRA releases: 2024-11 · check-in free text available
2022-10-01
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-10	Pfizer-BioNTech
2	2021-01-28	Pfizer-BioNTech
3	2021-09-28	Pfizer-BioNTech	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-02-25	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-02	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-30	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-02	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-03	Successful 2021-10-04	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-06	Successful 2021-10-12	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-10-01	Successful 2022-10-03	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 4 — day 21, dose 2

2021-02-18

Symptoms: Some diarrhea but have been taking a laxative

Release 4 — day 28, dose 2

2021-02-25

Symptoms: Developed urosepsis requiring short term hospitalization. Blood cultures demonstrated E Coli. Treated successfully with IV antibiotics. COVID test in hospital negative

Release 9 — 6 months, dose 2

2021-08-02

Symptoms: Developed Covid negative upper respiratory tract infection picked up from brother-in-law culminating in bronchitis. Lasted for over a week somewhat improved at present.

Release 9 — days 1–6 daily, dose 3

2021-09-30

Systemic reaction (other): Pneumonia and congestive heart failure

2021-10-02

Systemic reaction (other): These symptoms are not caused by covid. I have a another pre-existing condition. However I believe that the two vaccines I received - the Pfizer booster and flu precipitated my pre-existing medical condition.

2021-10-03

Systemic reaction (other): I believe my symptoms are not related to the receipt of the booster vaccine but I are rather the consequence of a pre-existing medical conditions

Release 10 — day 7, dose 3

2021-10-06

Systemic reaction (other): Symptoms unrelated to covid booster

Release 12 — 12 months, dose 3

2022-10-01

Symptoms: Cardiac problems requiring cardiac catheterization unassociated with covid

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	Blood culture positive	✓	✓	✓
SD	Bronchitis	✓	·	✓
SD	Cardiac disorder	·	·	✓
SD	Catheterisation cardiac	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Escherichia bacteraemia	○	○	○
SD	Escherichia infection	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Self-medication	✓	✓	✓
SD	Upper respiratory tract infection	✓	·	✓
SD	Urosepsis	✓	✓	✓
SRO	Adverse reaction	·	·	✓
SRO	Cardiac failure congestive	·	·	✓
SRO	Condition aggravated	·	·	✓
SRO	Pneumonia	·	·	✓
SRO	Pre-existing disease	·	·	✓

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