ZCN-14310-37963

2 vaccinations 8 coded responses 17 check-ins 8 free-text entries 7 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 853 / AZ
Registered: 2020-12-30

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

2020-12-30
Registered in v-safe
2020-12-30
Dose 1 — Pfizer-BioNTech
2020-12-30
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2020-12-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-06
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-13
Survey response — day 14, dose 1
MedDRA: New daily persistent headache — Feeling: Good

Free text: Daily headaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-20
Dose 2 — Pfizer-BioNTech
2021-01-27
Survey response — day 7, dose 2
MedDRA: Back pain — Feeling: Poor · Abdominal pain · Be unable to work, 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: Left lower back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — day 7, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-04
Survey response — day 14, dose 2
MedDRA: Abdominal pain, Back pain, Blood urine present, Crystal urine present, Pulmonary mass — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Left sided abdominal pain, left sided back pain, blood/calcium oxalates in urine, indeterminate lung nodule

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Report sent to call center — day 14, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-12
Survey response — day 21, dose 2
MedDRA: Abdominal pain, Back pain — Feeling: Poor · 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: Back pain, abdominal pain,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-17
Survey response — day 28, dose 2
MedDRA: Abdominal pain, Back pain — Feeling: Poor · 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: Left sided back pain and left sided abdominal pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-24
Survey response — day 35, dose 2
MedDRA: Abdominal pain, Back pain, Nausea, Skin burning sensation — Feeling: Poor · 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: Left side back pain. Left side abd pain. Nausea. Burning of skin of left abdomen and left back.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-21
Survey response — 3 months, dose 2
MedDRA: Agitation, Depression, Disturbance in attention, Petechiae — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Depression, agitation, poor concentration, petechiae on bilateral lower extremities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-08
Call 1 — Left Voicemail
2021-07-21
Survey response — 6 months, dose 2
MedDRA: Cystitis interstitial, Psychotic disorder, Sinusitis — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Psychosis, potentially evolving systemic lupus, interstitial cystitis, sinus infection

MedDRA releases: 2024-11 · check-in free text available
2021-07-21
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-27
Call 1 — Left Voicemail
2022-01-21
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-30	Pfizer-BioNTech
2	2021-01-20	Pfizer-BioNTech

Call center

Reported	Outcome	VAERS-related outcome
2021-01-27	Unsuccessful
2021-02-04	Unsuccessful
2021-02-12	Unsuccessful
2021-02-17	Unsuccessful
2021-02-24	Unsuccessful
2021-04-21	Unsuccessful
2021-07-21	Unsuccessful

Free text

Release 1 — day 14, dose 1

2021-01-13

Symptoms: Daily headaches

Release 2 — day 7, dose 2

2021-01-27

Systemic reaction (other): Left lower back pain

Release 3 — day 14, dose 2

2021-02-04

Symptoms: Left sided abdominal pain, left sided back pain, blood/calcium oxalates in urine, indeterminate lung nodule

Release 4 — day 21, dose 2

2021-02-12

Symptoms: Back pain, abdominal pain,

Release 4 — day 28, dose 2

2021-02-17

Symptoms: Left sided back pain and left sided abdominal pain

Release 4 — day 35, dose 2

2021-02-24

Symptoms: Left side back pain. Left side abd pain. Nausea. Burning of skin of left abdomen and left back.

Release 7 — 3 months, dose 2

2021-04-21

Symptoms: Depression, agitation, poor concentration, petechiae on bilateral lower extremities

Release 9 — 6 months, dose 2

2021-07-21

Symptoms: Psychosis, potentially evolving systemic lupus, interstitial cystitis, sinus infection

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	Abdominal pain	✓	✓	✓
SD	Agitation	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Blood urine present	✓	✓	✓
SD	Crystal urine present	✓	✓	✓
SD	Cystitis interstitial	·	·	✓
SD	Depression	✓	✓	✓
SD	Disturbance in attention	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	New daily persistent headache	✓	✓	✓
SD	Petechiae	✓	✓	✓
SD	Psychotic disorder	·	·	✓
SD	Pulmonary mass	✓	✓	✓
SD	Sinusitis	·	·	✓
SD	Skin burning sensation	✓	✓	✓
SRO	Back pain	✓	✓	✓

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