Z99-68856-16382

4 vaccinations 7 coded responses 28 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 274 / NC
Registered: 2021-03-02

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

2021-02-20
Dose 1 — Pfizer-BioNTech
2021-03-02
Registered in v-safe
2021-03-02
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-16
Dose 2 — Pfizer-BioNTech
2021-03-20
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling abnormal — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Foggy brain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-23
Health check-in — day 7, dose 2
Feeling: Fair · Site: Swelling · Fatigue or tiredness

Adult check-in
2021-03-30
Survey response — day 14, dose 2
MedDRA: Headache — Feeling: Fair

Free text: Headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Survey response — day 21, dose 2
MedDRA: Arthritis, Condition aggravated, Pain, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities

Free text: My herniated disc at L4 flared up. Severe pain. I noticed my arthritis joints hurt terribly 3 weeks after my 2nd shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — day 28, dose 2
MedDRA: Arthralgia, Arthritis, Pre-existing disease, Spinal pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Severe pain in lumbar back & hips. I have had arthritis for 20 years. All my pain areas flared up last week. It could be related to vaccine or total coincidence. I wanted to let you know. Severe pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Survey response — day 42, dose 2
MedDRA: Arthralgia, Back pain, Office visit, Pain, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Flare up of Ankyloking Spondylitis in every joint. Visit with my Ortho Surgeon. He gave me a Prednisone Dose Pack and my pain is bearable. Sever lumbar back and shooting down hip. Vaccine did not cause. It triggered huge immune reaction. · Healthcare visit (other): Office visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-15
Survey response — 3 months, dose 2
MedDRA: Office visit, Pain in extremity, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: I have peripheral neuropathy. My legs from toes to knees have been numb for over a decade. This month, feeling has been coming back. Per my docs, not possible. Good news but now I feel pain. I am working with my docs to see what is going on. · Healthcare visit (other): Doctors office. Rheumatologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-15
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-21
Call 1 — Left Voicemail
2021-09-14
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-09-26
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2021-10-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-10-03
Health check-in — day 7, dose 3
Feeling: Fair · None

Adult check-in
2021-10-12
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-10-17
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-10-24
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-10-31
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-11-07
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2021-12-26
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-03-27
Survey response — 6 months, dose 3
MedDRA: Hypersensitivity, Office visit, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Allergy flare-up. Have been symptom free for decades. High pollen count here. · Healthcare visit (other): Allergy physician office visit

MedDRA releases: 2024-11 · check-in free text available
2022-03-27
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-03-29
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-18
Dose 4 — Pfizer-BioNTech
2022-05-08
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-05-09
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-05-16
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-05-23
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-05-30
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-07-18
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-20	Pfizer-BioNTech
2	2021-03-16	Pfizer-BioNTech
3	2021-09-26	Pfizer-BioNTech	Flu
4	2022-04-18	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-27	Unsuccessful
2021-06-15	Unsuccessful
2022-03-27	Successful 2022-03-29	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-20

Systemic reaction (other): Foggy brain

Release 6 — day 14, dose 2

2021-03-30

Symptoms: Headache

Release 7 — day 21, dose 2

2021-04-08

Symptoms: My herniated disc at L4 flared up. Severe pain. I noticed my arthritis joints hurt terribly 3 weeks after my 2nd shot.

Release 7 — day 28, dose 2

2021-04-13

Symptoms: Severe pain in lumbar back & hips. I have had arthritis for 20 years. All my pain areas flared up last week. It could be related to vaccine or total coincidence. I wanted to let you know. Severe pain.

Release 8 — day 42, dose 2

2021-04-27

Symptoms: Flare up of Ankyloking Spondylitis in every joint. Visit with my Ortho Surgeon. He gave me a Prednisone Dose Pack and my pain is bearable. Sever lumbar back and shooting down hip. Vaccine did not cause. It triggered huge immune reaction.

Healthcare visit (other): Office visit

Release 9 — 3 months, dose 2

2021-06-15

Symptoms: I have peripheral neuropathy. My legs from toes to knees have been numb for over a decade. This month, feeling has been coming back. Per my docs, not possible. Good news but now I feel pain. I am working with my docs to see what is going on.

Healthcare visit (other): Doctors office. Rheumatologist.

Release 11 — 6 months, dose 3

2022-03-27

Symptoms: Allergy flare-up. Have been symptom free for decades. High pollen count here.

Healthcare visit (other): Allergy physician office visit

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	Arthritis	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypersensitivity	·	·	✓
SD	Office visit	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Spinal pain	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓

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