Z8K-31997-70511

3 vaccinations 5 coded responses 23 check-ins 5 free-text entries 2 call cases

Sex: Male
Age at first dose: 41-45
ZIP prefix: 363 / AL
Registered: 2021-01-04

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

2021-01-04
Registered in v-safe
2021-01-04
Dose 1 — Pfizer-BioNTech
2021-01-04
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-01-05
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-25
Dose 2 — Pfizer-BioNTech
2021-01-25
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Joint pains, Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-01-28
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Poor · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Abdominal pain

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-22
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-12-28
Dose 3 — Moderna
2022-01-25
Survey response — 12 months, dose 2
MedDRA: Back pain, Costochondritis, Emergency care, Gastrooesophageal reflux disease, Muscular weakness — Feeling: Poor · Be unable to work or attend school

Free text: Received Moderna booster on 12/28. On 12/30 developed Costochondritis, redlux, back pain and muscle weakness in limbs. Over the 4 weeks since shot, have been to ED twice; once by ambulance. Had EGD, ultrasounds, nothing noted. Still having symptoms.

MedDRA releases: 2024-11 · check-in free text available
2022-01-25
Survey response — day 28, dose 3
MedDRA: Back pain, Costochondritis, Fatigue, Gastritis, Gastrooesophageal reflux disease, Palpitations — Feeling: Poor · Be unable to work or attend school

Free text: Still ongoing costochondritis, back pain, reflux which is now gastritis. Body fatigue and heart palpitations.

MedDRA releases: 2024-11 · check-in free text available
2022-02-01
Survey response — day 35, dose 3
MedDRA: Abdominal pain upper, Back pain, Chest pain, Headache, Muscle fatigue, Pain in extremity — 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, Emergency room or emergency department visit

Free text: 5 weeks post booster. Still having chest pain, stomach ache, back pain and calf pain with headaches and bouts of limb fatigue. I regret getting the booster and noone will help me.

MedDRA releases: 2024-11 · check-in free text available
2022-02-01
Report sent to call center — day 35, 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

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-02-02
Call 1 — Left Voicemail
2022-02-02
Call successful
Completed over the phone
2022-02-08
Survey response — day 42, dose 3
MedDRA: Gastrooesophageal reflux disease, Sensation of foreign body — 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: 1 week ago, had onset of silent reflux with globus sensation.

MedDRA releases: 2024-11 · check-in free text available
2022-02-08
Report sent to call center — day 42, 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-10
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Pfizer-BioNTech
2	2021-01-25	Pfizer-BioNTech
3	2021-12-28	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-02-01	Successful 2022-02-02	Completed over the phone
2022-02-08	Unsuccessful

Free text

Release 2 — days 1–6 daily, dose 2

2021-01-28

Systemic reaction (other): Dizziness

Release 11 — day 28, dose 3

2022-01-25

Symptoms: Still ongoing costochondritis, back pain, reflux which is now gastritis. Body fatigue and heart palpitations.

Release 11 — 12 months, dose 2

2022-01-25

Symptoms: Received Moderna booster on 12/28. On 12/30 developed Costochondritis, redlux, back pain and muscle weakness in limbs. Over the 4 weeks since shot, have been to ED twice; once by ambulance. Had EGD, ultrasounds, nothing noted. Still having symptoms. cut off by CDC

Release 11 — day 35, dose 3

2022-02-01

Symptoms: 5 weeks post booster. Still having chest pain, stomach ache, back pain and calf pain with headaches and bouts of limb fatigue. I regret getting the booster and noone will help me.

Release 11 — day 42, dose 3

2022-02-08

Symptoms: 1 week ago, had onset of silent reflux with globus sensation.

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	Abdominal pain upper	·	·	✓
SD	Back pain	·	·	✓
SD	Chest pain	·	·	✓
SD	Costochondritis	·	·	✓
SD	Emergency care	·	·	✓
SD	Fatigue	·	·	✓
SD	Gastritis	·	·	✓
SD	Gastrooesophageal reflux disease	·	·	✓
SD	Headache	·	·	✓
SD	Muscle fatigue	·	·	✓
SD	Muscular weakness	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Palpitations	·	·	✓
SD	Sensation of foreign body	·	·	✓
SRO	Dizziness	✓	✓	✓

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