Z6T-27695-50568 · OpenVSafe

Timeline

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

2021-02-12
Dose 1 — Pfizer-BioNTech
2021-03-05
Dose 2 — Pfizer-BioNTech
2021-03-13
Registered in v-safe
2021-03-13
Survey response — day 7, dose 2
MedDRA: Balance disorder, Fatigue, Hospitalisation, Loss of consciousness, Office visit, Pre-existing disease, Skin laceration, Suture insertion — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · 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: Systemic reaction (other): The first day of actual Covid, I had a headache and passed out cold in the tub. Banged my head, shoulder, back, rib, and my new knee Recovered. That was 1/2/21. On 3/5/21 I had my second Pfizer shot. Got fatigue and passed out cold on tile flooring. 7 staples and 3 stitches in my temple. Three days hospitalized at (b)(6) Community in (b)(6). Still uneasy on my feet and symptomatic. I am normally an active and healthy 82 year old. · Healthcare visit (other): Dr. Visit yesterday. Seeing a Neurologist next.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Report sent to call center — day 7, 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
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-29
Survey response — day 21, dose 2
MedDRA: Arthralgia, COVID-19, Fatigue, Headache, Loss of consciousness, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Because of passing out from the second Pfiser shot, I have head and leg, foot, and shoulder pain so not all days are good. The Covid sickness sometimes feels it is lingering... like fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-12
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-17
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-12-16
Call 1 — Requested Callback
2021-12-20
Callback requested for
2021-12-21
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-12	Pfizer-BioNTech
2	2021-03-05	Pfizer-BioNTech

Call center

Reported	Outcome	VAERS-related outcome
2021-03-13	Successful 2021-12-21	Participant prefers to complete VAERS report online

Free text

Release 5 — day 7, dose 2

2021-03-13

Systemic reaction (other): The first day of actual Covid, I had a headache and passed out cold in the tub. Banged my head, shoulder, back, rib, and my new knee Recovered. That was 1/2/21. On 3/5/21 I had my second Pfizer shot. Got fatigue and passed out cold on tile flooring. 7 staples and 3 stitches in my temple. Three days hospitalized at (b)(6) Community in (b)(6). Still uneasy on my feet and symptomatic. I am normally an active and healthy 82 year old.

Healthcare visit (other): Dr. Visit yesterday. Seeing a Neurologist next.

redacted (b)(6)

Release 6 — day 21, dose 2

2021-03-29

Symptoms: Because of passing out from the second Pfiser shot, I have head and leg, foot, and shoulder pain so not all days are good. The Covid sickness sometimes feels it is lingering... like fatigue.

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	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	COVID-19	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Loss of consciousness	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SRO	Anxiety	○	○	○
SRO	Balance disorder	✓	✓	✓
SRO	Fall	○	○	○
SRO	Fatigue	✓	✓	✓
SRO	Headache	○	○	○
SRO	Hospitalisation	✓	✓	✓
SRO	Loss of consciousness	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Skin laceration	✓	✓	✓
SRO	Suture insertion	✓	✓	✓
SRO	Syncope	○	○	○

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