Z9B-24674-95132

4 vaccinations 14 coded responses 36 check-ins 13 free-text entries 1 call case

Sex: Female
Age at first dose: 46-50
ZIP prefix: 970 / OR
Registered: 2021-04-14

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

2021-04-06
Dose 1 — Pfizer-BioNTech
2021-04-14
Registered in v-safe
2021-04-14
Survey response — day 7, dose 1
MedDRA: Abdominal pain, Pre-existing disease — Feeling: Good · Abdominal pain

Free text: abd pain not related to vaccine - ongoing issue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-27
Dose 2 — Pfizer-BioNTech
2021-04-27
Survey response — day 0, dose 2
MedDRA: Unevaluable event — Feeling: Good

Free text: I only got the Jab 10 minutes ago... ask me tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain — Feeling: Good · Site: Pain · Fever · Abdominal pain

Free text: Chronic abd pain - not related to vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-04-30
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site bruising — Feeling: Good · Site: Swelling

Free text: Slight bruising at injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-01
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease — Feeling: Good · Abdominal pain

Free text: Abd pain chronic - not related to vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-04
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-18
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-06-01
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-27
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-26
Survey response — 6 months, dose 2
MedDRA: Abdominal discomfort, Lymphadenopathy, Pelvic discomfort — Feeling: Fair

Free text: Isolated enlarged left supraclavicular lymph node after flu vaccine last week; several weeks of lower abdominal/pelvic discomfort

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Dose 3 — Moderna
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2021-11-09
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site erythema, Injection site rash — Feeling: Fair · Site: Pain, Redness · Fever · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Rash/redness is about 5cm distal to the injection site

MedDRA releases: 2024-11 · check-in free text available
2021-11-10
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site erythema — Feeling: Good · Site: Pain, Redness, Itching · Rash, not including the immediate area around the injection site

Free text: Redness, etc describes area about 5cm distal to injection site

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site reaction — Feeling: Good · Site: Redness, Itching · Rash, not including the immediate area around the injection site

Free text: Above describes area 5cm distal to injection site

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site reaction, Injection site warmth, Rash pruritic — Feeling: Good · Site: Redness · Rash, not including the immediate area around the injection site

Free text: Rash 5 cm distal to injection site. Fading but still there. No longer itchy or hot.

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Survey response — day 7, dose 3
MedDRA: Injection site rash — Feeling: Good · Site: Redness · Headache, Rash, not including the immediate area around the injection site

Free text: Rash 5cm distal to injection site

MedDRA releases: 2024-11 · check-in free text available
2021-11-20
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-04
Survey response — day 28, dose 3
MedDRA: Abdominal pain, Pre-existing disease — Feeling: Fair

Free text: Abdominal pain/cramping. Not sure if it's my chronic issue (which has been better lately) or something new.

MedDRA releases: 2024-11 · check-in free text available
2021-12-11
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-18
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-05
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-07
Survey response — 6 months, dose 3
MedDRA: Arthralgia, Back pain, Joint effusion, Joint stiffness, Lymphadenopathy, Musculoskeletal stiffness, Pain in extremity, Peripheral swelling, Photophobia, Plantar fasciitis, Sacral pain, Unevaluable event — Feeling: Fair · 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: Symptoms: Low back/SI joint stiffness/pain, toe swelling and pain, worsening plantar fasciitis, ankle joint effusion, sensitivity to light. Also, persistent left supraclavicular lymphadenopathy since my booster. · Healthcare visit (other): X-ray, bloodwork, pending consultation

MedDRA releases: 2024-11 · check-in free text available
2022-05-07
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-09
Call 1 — Left Voicemail
2022-05-10
Call successful
Participant prefers to complete VAERS report online
2022-10-15
Dose 4 — Pfizer-BioNTech
2022-11-07
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-12
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-19
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-26
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-01-14
Survey response — 3 months, dose 4
MedDRA: Nasopharyngitis, SARS-CoV-2 test negative — Feeling: Fair

MedDRA releases: 2024-11
2023-04-17
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-06	Pfizer-BioNTech
2	2021-04-27	Pfizer-BioNTech
3	2021-11-06	Moderna	No
4	2022-10-15	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-07	Successful 2022-05-10	Participant prefers to complete VAERS report online

Free text

Release 7 — day 7, dose 1

2021-04-14

Systemic reaction (other): abd pain not related to vaccine - ongoing issue

Release 8 — day 0, dose 2

2021-04-27

Systemic reaction (other): I only got the Jab 10 minutes ago... ask me tomorrow

Release 8 — days 1–6 daily, dose 2

2021-04-28

Systemic reaction (other): Chronic abd pain - not related to vaccine.

2021-04-30

Systemic reaction (other): Slight bruising at injection site

2021-05-01

Systemic reaction (other): Abd pain chronic - not related to vaccine

Release 10 — 6 months, dose 2

2021-10-26

Symptoms: Isolated enlarged left supraclavicular lymph node after flu vaccine last week; several weeks of lower abdominal/pelvic discomfort

Release 10 — days 1–6 daily, dose 3

2021-11-09

Systemic reaction (other): Rash/redness is about 5cm distal to the injection site

2021-11-10

Systemic reaction (other): Redness, etc describes area about 5cm distal to injection site

2021-11-11

Systemic reaction (other): Above describes area 5cm distal to injection site

2021-11-12

Systemic reaction (other): Rash 5 cm distal to injection site. Fading but still there. No longer itchy or hot.

Release 10 — day 7, dose 3

2021-11-13

Systemic reaction (other): Rash 5cm distal to injection site

Release 10 — day 28, dose 3

2021-12-04

Symptoms: Abdominal pain/cramping. Not sure if it's my chronic issue (which has been better lately) or something new.

Release 11 — 6 months, dose 3

2022-05-07

Symptoms: Low back/SI joint stiffness/pain, toe swelling and pain, worsening plantar fasciitis, ankle joint effusion, sensitivity to light. Also, persistent left supraclavicular lymphadenopathy since my booster.

Healthcare visit (other): X-ray, bloodwork, pending consultation

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	Unevaluable event	·	·	✓
SD	Abdominal discomfort	·	·	✓
SD	Abdominal pain	·	·	✓
SD	Arthralgia	·	·	✓
SD	Back pain	·	·	✓
SD	Joint effusion	·	·	✓
SD	Joint stiffness	·	·	✓
SD	Lymphadenopathy	·	·	✓
SD	Musculoskeletal stiffness	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pelvic discomfort	·	·	✓
SD	Peripheral swelling	·	·	✓
SD	Photophobia	·	·	✓
SD	Plantar fasciitis	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Sacral pain	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Abdominal pain	✓	✓	✓
SRO	Injection site bruising	✓	✓	✓
SRO	Injection site erythema	·	·	✓
SRO	Injection site rash	·	·	✓
SRO	Injection site reaction	·	·	✓
SRO	Injection site warmth	·	·	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rash pruritic	·	·	✓
SRO	Unevaluable event	✓	✓	✓

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