Z9P-83888-01795

4 vaccinations 15 coded responses 47 check-ins 15 free-text entries 2 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 462 / IN
Registered: 2021-01-23

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

SX2-22878-94573 Child or adolescent in my care · Male · 2022-12-02

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-01-23
Registered in v-safe
2021-01-23
Dose 1 — Pfizer-BioNTech
2021-01-23
Health check-in — day 0, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-25
Survey response — days 1–6 daily, dose 1
MedDRA: Breast tenderness — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Tenderness in left breast (received shot in left arm)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Survey response — days 1–6 daily, dose 1
MedDRA: Breast tenderness — Feeling: Fair · Fever · Headache, Fatigue or tiredness

Free text: Tenderness in my breasts

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-30
Health check-in — day 7, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-02-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-17
Dose 2 — Pfizer-BioNTech
2021-02-17
Survey response — day 0, dose 2
MedDRA: Dizziness — Feeling: Fair

Free text: Woozy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Chills, Muscle or body aches, Fatigue or tiredness

Free text: Woozy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Breast tenderness — Feeling: Good · Fatigue or tiredness

Free text: Tenderness in left breast (injection in left arm)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue, Memory impairment — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Realized that on 2/18 I have a 90 minute gap in my memory, which Im guessing was due to fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Diarrhea

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-24
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-03
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-17
Survey response — day 28, dose 2
MedDRA: Cough, Nasopharyngitis, Oropharyngeal pain, Rhinorrhoea — Feeling: Fair

Free text: Have a head cold with cough, runny nose, and sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Survey response — day 35, dose 2
MedDRA: Diarrhoea, Gastroenteritis viral, Pyrexia — Feeling: Good · Be unable to do your normal daily activities

Free text: Stomach virus- low grade fever and diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-19
Survey response — 3 months, dose 2
MedDRA: Cough, Gastroenteritis viral, Nasopharyngitis, Rhinorrhoea, Sneezing, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Vomiting from stomach bug; cough and runny nose from cold

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-19
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-04
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2021-12-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-12-06
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain — Feeling: Good

Free text: Soreness in my armpit

MedDRA releases: 2024-11 · check-in free text available
2021-12-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-09
Survey response — days 1–6 daily, dose 3
MedDRA: Oropharyngeal pain, Sneezing — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Sore throat, sneezing

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Survey response — days 1–6 daily, dose 3
MedDRA: Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test — Feeling: Fair · Headache, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Runny nose, congestion · Healthcare visit (other): Took at home Covid-19 rapid test

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-11
Survey response — day 7, dose 3
MedDRA: Office visit, SARS-CoV-2 test positive — Feeling: Fair · Fever · Fatigue or tiredness · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Tested positive for Covid with a rapid test at a clinic

MedDRA releases: 2024-11 · check-in free text available
2021-12-11
Report sent to call center — day 7, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-15
Call 1 — Left Voicemail
2021-12-15
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-18
Survey response — day 14, dose 3
MedDRA: Ageusia, Anosmia, Headache, Rhinorrhoea — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Loss of taste and smell, headaches, runny nose

MedDRA releases: 2024-11 · check-in free text available
2021-12-25
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-01
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-08
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-16
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-05
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-06
Survey response — 6 months, dose 3
MedDRA: Pregnancy — Feeling: Fair

Free text: Pregnancy

MedDRA releases: 2024-11 · check-in free text available
2022-10-21
Dose 4 — Pfizer-BioNTech
2022-11-03
Health check-in — day 7, dose 4
Feeling: Fair · None

Adult check-in
2022-11-04
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-11-11
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-18
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-26
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-02
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-01-20
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-04-21
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-23	Pfizer-BioNTech
2	2021-02-17	Pfizer-BioNTech
3	2021-12-04	Pfizer-BioNTech	Flu
4	2022-10-21	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-12-10	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-11	Successful 2021-12-15	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-25

Systemic reaction (other): Tenderness in left breast (received shot in left arm)

2021-01-26

Systemic reaction (other): Tenderness in my breasts

Release 4 — day 0, dose 2

2021-02-17

Systemic reaction (other): Woozy

Release 4 — days 1–6 daily, dose 2

2021-02-18

Systemic reaction (other): Woozy

2021-02-19

Systemic reaction (other): Tenderness in left breast (injection in left arm)

2021-02-20

Systemic reaction (other): Realized that on 2/18 I have a 90 minute gap in my memory, which Im guessing was due to fatigue

Release 5 — day 28, dose 2

2021-03-17

Symptoms: Have a head cold with cough, runny nose, and sore throat

Release 6 — day 35, dose 2

2021-03-24

Symptoms: Stomach virus- low grade fever and diarrhea

Release 8 — 3 months, dose 2

2021-05-19

Symptoms: Vomiting from stomach bug; cough and runny nose from cold

Release 10 — days 1–6 daily, dose 3

2021-12-06

Systemic reaction (other): Soreness in my armpit

2021-12-09

Systemic reaction (other): Sore throat, sneezing

2021-12-10

Systemic reaction (other): Runny nose, congestion

Healthcare visit (other): Took at home Covid-19 rapid test

Release 10 — day 7, dose 3

2021-12-11

Systemic reaction (other): Tested positive for Covid with a rapid test at a clinic

Release 10 — day 14, dose 3

2021-12-18

Symptoms: Loss of taste and smell, headaches, runny nose

Release 11 — 6 months, dose 3

2022-06-06

Symptoms: Pregnancy

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	SARS-CoV-2 test	·	·	✓
SD	Ageusia	·	·	✓
SD	Anosmia	·	·	✓
SD	Cough	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Gastroenteritis viral	✓	✓	✓
SD	Headache	·	·	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pregnancy	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Sneezing	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Axillary pain	·	·	✓
SRO	Breast tenderness	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Memory impairment	✓	✓	✓
SRO	Office visit	·	·	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Respiratory tract congestion	·	·	✓
SRO	Rhinorrhoea	·	·	✓
SRO	SARS-CoV-2 test positive	·	·	✓
SRO	Sneezing	·	·	✓

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