ZC2-28598-42017

1 vaccination 7 coded responses 14 check-ins 7 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 958 / CA
Registered: 2021-02-17

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

2021-02-16
Dose 1 — Pfizer-BioNTech
2021-02-17
Registered in v-safe
2021-02-17
Survey response — days 1–6 daily, dose 1
MedDRA: Diarrhoea, Dry mouth, Flushing, Loss of consciousness, Muscle spasms, Rash — Feeling: Good · Chills, Headache · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Today mild symptoms; however, 30 minutes after shot: lost consciousness, extreme diarrhea, cramping, face rash, flushing, extremely dry mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-19
Survey response — days 1–6 daily, dose 1
MedDRA: Hospitalisation, Hypersensitivity — Feeling: Poor · Chills, Headache, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Allergic reaction. In hospital ER all day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-20
Survey response — days 1–6 daily, dose 1
MedDRA: Swelling face — Feeling: Poor · Chills, Headache · Be unable to do your normal daily activities

Free text: Face swelling

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Survey response — days 1–6 daily, dose 1
MedDRA: Hospitalisation, Swelling face — Feeling: Poor · Chills, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Face swelling; hospitalized Friday due to reaction to shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — days 1–6 daily, dose 1
MedDRA: Swelling face — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Swollen face

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-23
Survey response — day 7, dose 1
MedDRA: Swelling face — Feeling: Poor · Chills, Headache · Be unable to work, Be unable to do your normal daily activities

Free text: Face swollen

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-03-09
Survey response — day 21, dose 1
MedDRA: Anaphylactic reaction, Balance disorder, Immunisation reaction, Incomplete course of vaccination, Respiratory tract congestion, Sinus headache, Specialist consultation — Feeling: Fair · 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: Sinus headache, extreme congestion affecting equilibrium. Prescription medication req'd to relieve symptoms. Did not get 2nd COVID vaccine on advice of 3 doctors due to severe allergic reaction characteristic of anaphylaxis.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-16
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-03-23
Health check-in — day 35, dose 1
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 42, dose 1
Feeling: Good

Adult check-in
2021-05-18
Health check-in — 3 months, dose 1
Feeling: Good

Adult check-in
2021-07-30
Call 1 — Left Voicemail
2021-08-17
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2022-02-18
Health check-in — 12 months, dose 1
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-16	Pfizer-BioNTech

Call center

Reported	Outcome	VAERS-related outcome
2021-02-17	Unsuccessful
2021-02-19	Unsuccessful
2021-02-22	Unsuccessful
2021-03-09	Unsuccessful

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-17

Systemic reaction (other): Today mild symptoms; however, 30 minutes after shot: lost consciousness, extreme diarrhea, cramping, face rash, flushing, extremely dry mouth

2021-02-19

Systemic reaction (other): Allergic reaction. In hospital ER all day.

2021-02-20

Systemic reaction (other): Face swelling

2021-02-21

Systemic reaction (other): Face swelling; hospitalized Friday due to reaction to shot

2021-02-22

Systemic reaction (other): Swollen face

Release 4 — day 7, dose 1

2021-02-23

Systemic reaction (other): Face swollen

Release 5 — day 21, dose 1

2021-03-09

Symptoms: Sinus headache, extreme congestion affecting equilibrium. Prescription medication req'd to relieve symptoms. Did not get 2nd COVID vaccine on advice of 3 doctors due to severe allergic reaction characteristic of anaphylaxis.

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	Anaphylactic reaction	✓	✓	✓
SD	Balance disorder	✓	✓	✓
SD	Immunisation reaction	✓	✓	✓
SD	Incomplete course of vaccination	✓	✓	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Sinus headache	✓	✓	✓
SD	Specialist consultation	✓	✓	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Dry mouth	✓	✓	✓
SRO	Flushing	✓	✓	✓
SRO	Hospitalisation	✓	✓	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Loss of consciousness	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Swelling face	✓	✓	✓

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