Z7D-11705-38787

4 vaccinations 5 coded responses 33 check-ins 5 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 837 / ID
Registered: 2020-12-20

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

2020-12-20
Registered in v-safe
2020-12-20
Dose 1 — Pfizer-BioNTech
2020-12-20
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2020-12-21
Survey response — days 1–6 daily, dose 1
MedDRA: Malaise — Feeling: Fair · Fever · Fatigue or tiredness

Free text: Just feel punky, not bad enough to keep me home from work. Feeling of maybe having a low grade fever is entirely subjective.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-22
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling abnormal — Feeling: Fair · Fatigue or tiredness

Free text: Still feeling punky, but much less than yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-23
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2020-12-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-27
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-10
Dose 2 — Pfizer-BioNTech
2021-01-10
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-01-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-01-31
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-02-21
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-12
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-11
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-09-08
Dose 3 — Pfizer-BioNTech
2021-09-28
Survey response — day 14, dose 3
MedDRA: Ageusia, Anosmia, Aphonia, Chills, Decreased appetite, Dysgeusia, Hyperhidrosis, Nausea, Oropharyngeal pain, Parosmia, Productive cough, Pyrexia, Vomiting — 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

Free text: 9/12/21. Extreme sore throat, loss of voice, freq productive cough, fevers w/rigors, extreme, sudden diaphoresis, loss of taste and smell except for strong foul odor/taste could not identify, near daily sudden onset nausea/vomiting, loss of appetite

MedDRA releases: 2024-11 · check-in free text available
2021-09-28
Report sent to call center — day 14, dose 3
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)
2021-09-29
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-09-30
Call 2 — Left Voicemail
2021-09-30
Call successful
Does not wish to fill out VAERS report
2021-10-06
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-10-13
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-10-20
Survey response — day 42, dose 3
MedDRA: Breakthrough COVID-19, Influenza like illness, Pyrexia, SARS-CoV-2 test positive — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Lingering low grade fevers presumably due to my case of breakthrough COVID. (I developed symptoms & subsequently tested positive 4 days after receiving my booster shot). Waxing & waning flu like symptoms to go along with intermittent low grade fever

MedDRA releases: 2024-11 · check-in free text available
2021-10-20
Report sent to call center — day 42, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-21
Call 2 — Left Voicemail
2021-12-08
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-02-15
Dose 4 — Moderna
2022-03-10
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-05-18
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-08-16
Survey response — 6 months, dose 4
MedDRA: Condition aggravated, Office visit, Pre-existing disease — 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

Free text: Symptoms: I have been diagnosed with Long-haul COVID & have con't to experience flares/exacerbations at freq intervals. The S/S are the same as I experienced with the original COVID infection, & they con't unabated to this day. · Healthcare visit (other): Referral to local COVID Recovery Clinic (CRC) & multiple specialist referral, studies, & in depth work-up; most recent vaccine booster rec'd 8/12 (5 doses total; Pfizer & Moderna both for "mix-n-match" effect.

MedDRA releases: 2024-11 · check-in free text available
2022-08-16
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)
2022-08-17
Call 1 — Could Not Reach Participant
2022-08-17
Call 1 — Requested Callback
2022-08-17
Call 1 — Requested Callback
2022-08-18
Callback requested for
3:00PM ET
2022-08-18
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-18
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-16
Health check-in — 12 months, dose 4
Feeling: Poor

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-20	Pfizer-BioNTech
2	2021-01-10	Pfizer-BioNTech
3	2021-09-08	Pfizer-BioNTech	No
4	2022-02-15	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-28	Successful 2021-09-30	Does not wish to fill out VAERS report
2021-10-20	Successful 2022-08-18	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-16	Successful 2022-08-18	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 1 — days 1–6 daily, dose 1

2020-12-21

Systemic reaction (other): Just feel punky, not bad enough to keep me home from work. Feeling of maybe having a low grade fever is entirely subjective.

2020-12-22

Systemic reaction (other): Still feeling punky, but much less than yesterday

Release 9 — day 14, dose 3

2021-09-28

Symptoms: 9/12/21. Extreme sore throat, loss of voice, freq productive cough, fevers w/rigors, extreme, sudden diaphoresis, loss of taste and smell except for strong foul odor/taste could not identify, near daily sudden onset nausea/vomiting, loss of appetite cut off by CDC

Release 10 — day 42, dose 3

2021-10-20

Symptoms: Lingering low grade fevers presumably due to my case of breakthrough COVID. (I developed symptoms & subsequently tested positive 4 days after receiving my booster shot). Waxing & waning flu like symptoms to go along with intermittent low grade fever cut off by CDC

Release 12 — 6 months, dose 4

2022-08-16

Symptoms: I have been diagnosed with Long-haul COVID & have con't to experience flares/exacerbations at freq intervals. The S/S are the same as I experienced with the original COVID infection, & they con't unabated to this day.

Healthcare visit (other): Referral to local COVID Recovery Clinic (CRC) & multiple specialist referral, studies, & in depth work-up; most recent vaccine booster rec'd 8/12 (5 doses total; Pfizer & Moderna both for "mix-n-match" effect.

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	Ageusia	·	·	✓
SD	Anosmia	·	·	✓
SD	Aphonia	·	·	✓
SD	Breakthrough COVID-19	·	·	✓
SD	Chills	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Decreased appetite	·	·	✓
SD	Dysgeusia	·	·	✓
SD	Hyperhidrosis	·	·	✓
SD	Influenza like illness	·	·	✓
SD	Nausea	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Parosmia	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Productive cough	·	·	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Vomiting	·	·	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Malaise	✓	✓	✓

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