Z9V-67939-32904

1 vaccination 8 coded responses 13 check-ins 8 free-text entries 6 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 446 / OH
Registered: 2021-12-04

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

2021-12-03
Dose 1 — Pfizer-BioNTech
2021-12-04
Registered in v-safe
2021-12-04
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Emergency care, Heart rate increased — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Chest pain , elevated heart rate requiring ER visit 12/3

MedDRA releases: 2024-11 · check-in free text available
2021-12-04
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2021-12-05
Survey response — days 1–6 daily, dose 1
MedDRA: Medical counselling, Unevaluable event — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): I was notified 12/3/21 that I received 6 times of the recommended dose · Healthcare visit (other): Primary care physician was notified

MedDRA releases: 2024-11 · check-in free text available
2021-12-05
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-06
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate increased — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to work or attend school

Free text: Elevated heart rate

MedDRA releases: 2024-11 · check-in free text available
2021-12-07
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate increased — Feeling: Fair · Site: Pain · Headache · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Elevated heart rate

MedDRA releases: 2024-11 · check-in free text available
2021-12-07
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-07
Call 1 — Left Voicemail
2021-12-07
Call successful
Participant prefers to complete VAERS report online
2021-12-08
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate increased, Palpitations, Unevaluable event — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Increased heart rate / heart racing . · Healthcare visit (other): Cardiac monitoring

MedDRA releases: 2024-11 · check-in free text available
2021-12-08
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-08
Call 1 — Left Voicemail
2021-12-09
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate increased, Office visit, Palpitations — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Increased heart rate , palpitations · Healthcare visit (other): Outpatient Cardiac monitoring

MedDRA releases: 2024-11 · check-in free text available
2021-12-09
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-09
Call successful
Participant prefers to complete VAERS report online
2021-12-10
Survey response — day 7, dose 1
MedDRA: Heart rate increased, Palpitations — Feeling: Fair

Free text: Palpitations / increased heart rate

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Call successful
Participant prefers to complete VAERS report online
2021-12-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-12-24
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-12-31
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2022-01-07
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2022-01-17
Health check-in — day 42, dose 1
Feeling: Good

Adult check-in
2022-06-05
Survey response — 6 months, dose 1
MedDRA: Abortion spontaneous — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Miscarriage

MedDRA releases: 2024-11 · check-in free text available
2022-06-05
Report sent to call center — 6 months, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-06-06
Call successful
Completed over the phone

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-12-03	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-12-04	Successful	Participant prefers to complete VAERS report online
2021-12-05	Successful 2021-12-07	Participant prefers to complete VAERS report online
2021-12-07	Successful	Participant prefers to complete VAERS report online
2021-12-08	Successful 2021-12-09	Participant prefers to complete VAERS report online
2021-12-09	Successful 2021-12-10	Participant prefers to complete VAERS report online
2022-06-05	Successful 2022-06-06	Completed over the phone

Free text

Release 10 — days 1–6 daily, dose 1

2021-12-04

Systemic reaction (other): Chest pain , elevated heart rate requiring ER visit 12/3

2021-12-05

Systemic reaction (other): I was notified 12/3/21 that I received 6 times of the recommended dose

Healthcare visit (other): Primary care physician was notified

2021-12-06

Systemic reaction (other): Elevated heart rate

2021-12-07

Systemic reaction (other): Elevated heart rate

2021-12-08

Systemic reaction (other): Increased heart rate / heart racing .

Healthcare visit (other): Cardiac monitoring

2021-12-09

Systemic reaction (other): Increased heart rate , palpitations

Healthcare visit (other): Outpatient Cardiac monitoring

Release 10 — day 7, dose 1

2021-12-10

Systemic reaction (other): Palpitations / increased heart rate

Release 11 — 6 months, dose 1

2022-06-05

Symptoms: Miscarriage

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	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Abortion spontaneous	·	·	✓
SRO	Chest pain	·	·	✓
SRO	Emergency care	·	·	✓
SRO	Heart rate increased	·	·	✓
SRO	Medical counselling	·	·	✓
SRO	Palpitations	·	·	✓

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