Z7C-81778-58462

4 vaccinations 7 coded responses 30 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 493 / MI
Registered: 2021-03-09

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

2021-03-03
Dose 1 — Pfizer-BioNTech
2021-03-09
Registered in v-safe
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Rash, not including the immediate area around the injection site

Adult check-in
2021-03-10
Survey response — day 7, dose 1
MedDRA: Urticaria — Feeling: Fair · Rash, not including the immediate area around the injection site

Free text: Intermittent hives on arms, hands, leg & foot (b)(6) due to (b)(6)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-31
Dose 2 — Pfizer-BioNTech
2021-03-31
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-04-07
Health check-in — day 7, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

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

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

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

Adult check-in
2021-05-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-12
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-30
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-29
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-21
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2022-04-02
Survey response — 12 months, dose 2
MedDRA: Antinuclear antibody positive, Immune system disorder, Office visit, Red blood cell sedimentation rate increased, Rheumatoid factor positive, Sjogren's syndrome — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Diagnosed w/Immune Disorder/Doctor still in the midst of exact diagnosis. Sedimentation Rate=58/standard 0-20mm, ANA Screening=Positive, Rheumatoid Factor IGM= >200/standard <3 IU/mL, Anti NuclearAntibody HEP2=Positive, Positive=Sjorgen Syndrome A&B

MedDRA releases: 2024-11 · check-in free text available
2022-04-02
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-07
Call 1 — Left Voicemail
2022-04-21
Dose 4 — Pfizer-BioNTech
2022-04-24
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2022-04-25
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2022-05-05
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-12
Survey response — day 21, dose 4
MedDRA: SARS-CoV-2 test positive — 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 · Outpatient clinic or urgent care clinic visit

Free text: Tested positive for COVID

MedDRA releases: 2024-11 · check-in free text available
2022-05-12
Report sent to call center — day 21, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-13
Call 2 — Left Voicemail
2022-05-13
Call 1 — Left Voicemail
2022-05-19
Health check-in — day 28, dose 4
Feeling: Poor

Adult check-in
2022-05-26
Survey response — day 35, dose 4
MedDRA: Ear pain, Fatigue, Headache, Pain, Pyrexia, Respiratory tract congestion — Feeling: Poor · Be unable to do your normal daily activities

Free text: headache, congestion, low-grade fever, earaches, aches, fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-06-02
Survey response — day 42, dose 4
MedDRA: Migraine, Oesophageal achalasia, Pyrexia, Sinus congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: Migraines, achy, sinus congestion, intermittent fever

MedDRA releases: 2024-11 · check-in free text available
2022-07-21
Survey response — 3 months, dose 4
MedDRA: Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Long COVID

MedDRA releases: 2024-11 · check-in free text available
2022-10-22
Survey response — 6 months, dose 4
MedDRA: Oxygen saturation decreased — 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

Free text: Air Oxygen levels low

MedDRA releases: 2024-11 · check-in free text available
2022-10-22
Report sent to call center — 6 months, dose 4
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 · 1 call case(s)
2022-10-25
Call 3 — Left Voicemail
2022-10-25
Call 2 — Left Voicemail
2022-10-25
Call 1 — Left Voicemail
2023-04-21
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-03	Pfizer-BioNTech
2	2021-03-31	Pfizer-BioNTech
3	2021-10-21	Pfizer-BioNTech	Flu
4	2022-04-21	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-04-02	Unsuccessful
2022-05-12	Unsuccessful
2022-10-22	Unsuccessful

Free text

Release 5 — day 7, dose 1

2021-03-10

Systemic reaction (other): Intermittent hives on arms, hands, leg & foot (b)(6) due to (b)(6)

redacted (b)(6)

Release 11 — 12 months, dose 2

2022-04-02

Symptoms: Diagnosed w/Immune Disorder/Doctor still in the midst of exact diagnosis. Sedimentation Rate=58/standard 0-20mm, ANA Screening=Positive, Rheumatoid Factor IGM= >200/standard <3 IU/mL, Anti NuclearAntibody HEP2=Positive, Positive=Sjorgen Syndrome A&B cut off by CDC

Release 11 — day 21, dose 4

2022-05-12

Symptoms: Tested positive for COVID

Release 11 — day 35, dose 4

2022-05-26

Symptoms: headache, congestion, low-grade fever, earaches, aches, fatigue

Release 11 — day 42, dose 4

2022-06-02

Symptoms: Migraines, achy, sinus congestion, intermittent fever

Release 12 — 3 months, dose 4

2022-07-21

Symptoms: Long COVID

Release 12 — 6 months, dose 4

2022-10-22

Symptoms: Air Oxygen levels low

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	Antinuclear antibody positive	·	·	✓
SD	Ear pain	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Immune system disorder	·	·	✓
SD	Migraine	·	·	✓
SD	Oesophageal achalasia	·	·	✓
SD	Office visit	·	·	✓
SD	Oxygen saturation decreased	·	·	✓
SD	Pain	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Red blood cell sedimentation rate increased	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rheumatoid factor positive	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sinus congestion	·	·	✓
SD	Sjogren's syndrome	·	·	✓
SRO	Urticaria	✓	✓	✓

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