ZD7-69061-17290

3 vaccinations 20 coded responses 24 check-ins 20 free-text entries 2 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 707 / LA
Registered: 2021-08-26

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-08-26
Registered in v-safe
2021-08-26
Dose 1 — Pfizer-BioNTech
2021-08-26
Survey response — day 0, dose 1
MedDRA: Dyspnoea — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Difficulty breathing at times

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-27
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: SOB at times

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-28
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Dyspnoea, Rash, Rash pruritic — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Itchy rash below right knee. Continue to have SOB at times. Mild chest pain since yesterday evening

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-29
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Dyspnoea, Rash — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Rash still present below right knee. Still having mild chest pain and SOB at times

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-30
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Chest pain, Dyspnoea, Rash — Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: SOB at times. Rash still below right knee and pain to knee. Mild chest pains.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-01
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-09-11
Survey response — day 14, dose 1
MedDRA: Contusion, Coordination abnormal, Dyspnoea, Fall, Headache, Injection site reaction, Pain in extremity, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Thermal burn — Feeling: Fair · Be unable to do your normal daily activities

Free text: I have a burn mark on my arm from injection site. Mild pain to left arm. Loss of coordination. Fell and bruised my arms and legs. Still having headaches. SOB not as frequent using inhaler now. Continue to run low grade fever. Runny nose and congestio

MedDRA releases: 2024-11 · check-in free text available
2021-09-22
Dose 2 — Pfizer-BioNTech
2021-09-23
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-09-24
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain upper, Chills, Menstruation irregular, Oropharyngeal pain, Rhinorrhoea — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Having severe stomach pain then menstrual bleeding started 3 days early. Severe chills. Runny nose and sore throat

MedDRA releases: 2024-11 · check-in free text available
2021-09-25
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain upper, Abnormal menstrual clots, Diarrhoea — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Passing lots of blood clots since menses came down early. Diarrhea started today with severe stomach pain.

MedDRA releases: 2024-11 · check-in free text available
2021-09-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-09-27
Survey response — days 1–6 daily, dose 2
MedDRA: Eye disorder, Headache, Office visit — Feeling: Poor · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, 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: Headache very severe today causing problems with right eye. Had to see a specialist

MedDRA releases: 2024-11 · check-in free text available
2021-09-27
Report sent to call center — days 1–6 daily, 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-09-29
Survey response — day 7, dose 2
MedDRA: Epistaxis, Headache, Lymphadenopathy, Oligomenorrhoea, Rhinorrhoea, Visual impairment — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Runny nose, experienced nose bleed this morning. Severe headache causing problems with vision. Menstural cycle lasted more days than normal. Right lymph nodes are swollen

MedDRA releases: 2024-11 · check-in free text available
2021-09-29
Call 1 — Left Voicemail
2021-10-06
Survey response — day 14, dose 2
MedDRA: Chills, Headache, Nephritis, Pyrexia — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Kidney inflammation. Headaches are mild. Still running low grade fever and chills

MedDRA releases: 2024-11 · check-in free text available
2021-10-15
Survey response — day 21, dose 2
MedDRA: Epistaxis, Fatigue, Feeding disorder, Headache, Nausea, Renal pain, Vomiting — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Severe headaches, nausea and vomiting. Unable to eat most times. Drinking Boost. Nosebleeds. Kidney pain. Remain fatigued.

MedDRA releases: 2024-11 · check-in free text available
2021-10-22
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-10-27
Survey response — day 35, dose 2
MedDRA: Dizziness, Headache, Hypotension, Pain, Rhinorrhoea — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Dizziness, body aches, runny nose , headaches low blood pressure

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Survey response — day 42, dose 2
MedDRA: Decreased appetite, Dizziness, Ear pain, Fatigue, Headache, Lymphadenopathy, Weight decreased — 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: Continue fatigue. Loss of appetite and weight loss. Headaches continue. Dizziness, earache, swollen lymph node.

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Report sent to call center — day 42, dose 2
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)
2021-11-08
Call successful
Participant prefers to complete VAERS report online
2021-12-25
Survey response — 3 months, dose 2
MedDRA: Asthenia, Balance disorder, Cluster headache, Contusion, Nausea, Oropharyngeal pain, Rhinorrhoea — Feeling: Poor · Be unable to do your normal daily activities

Free text: Nausea and cluster headaches are back. Bruising occurring to b/l Lower extremities. Off balance. Runny nose and sore throat. No energy

MedDRA releases: 2024-11 · check-in free text available
2022-02-09
Dose 3 — Pfizer-BioNTech
2022-02-22
Survey response — day 7, dose 3
MedDRA: Decreased appetite — Feeling: Fair · Site: Itching · Chills, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Loss of appetite,

MedDRA releases: 2024-11 · check-in free text available
2022-02-23
Survey response — day 14, dose 3
MedDRA: Headache, Lymphadenopathy, Rhinorrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Lymph nodes swollen. Runny nose slight headache

MedDRA releases: 2024-11 · check-in free text available
2022-03-02
Survey response — day 21, dose 3
MedDRA: Contusion, Fatigue, Injection site pain, Lymphadenopathy, Pain, Rash — Feeling: Fair · Be unable to do your normal daily activities

Free text: Bruising and rash to lower right leg, swollen glands moderate pain, soreness at injection site, fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-03-10
Survey response — day 28, dose 3
MedDRA: Contusion, Fatigue, Lymphadenopathy, Neck pain, Rhinorrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Pain at side of neck. Glands swollen. More bruising to lower extremities. Fatigue and runny nose

MedDRA releases: 2024-11 · check-in free text available
2022-05-11
Survey response — 3 months, dose 3
MedDRA: Amnesia, Dysphemia, Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Some memory loss /stutter sometimes while talking. Continue to experience fatigue

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-08-26	Pfizer-BioNTech	No
2	2021-09-22	Pfizer-BioNTech	No
3	2022-02-09	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-27	Successful	Participant prefers to complete VAERS report online
2021-11-04	Successful 2021-11-08	Participant prefers to complete VAERS report online

Free text

Release 9 — day 0, dose 1

2021-08-26

Systemic reaction (other): Difficulty breathing at times

Release 9 — days 1–6 daily, dose 1

2021-08-27

Systemic reaction (other): SOB at times

2021-08-28

Systemic reaction (other): Itchy rash below right knee. Continue to have SOB at times. Mild chest pain since yesterday evening

2021-08-29

Systemic reaction (other): Rash still present below right knee. Still having mild chest pain and SOB at times

2021-08-30

Systemic reaction (other): SOB at times. Rash still below right knee and pain to knee. Mild chest pains.

Release 9 — day 14, dose 1

2021-09-11

Symptoms: I have a burn mark on my arm from injection site. Mild pain to left arm. Loss of coordination. Fell and bruised my arms and legs. Still having headaches. SOB not as frequent using inhaler now. Continue to run low grade fever. Runny nose and congestio cut off by CDC

Release 9 — days 1–6 daily, dose 2

2021-09-24

Systemic reaction (other): Having severe stomach pain then menstrual bleeding started 3 days early. Severe chills. Runny nose and sore throat

2021-09-25

Systemic reaction (other): Passing lots of blood clots since menses came down early. Diarrhea started today with severe stomach pain.

2021-09-27

Systemic reaction (other): Headache very severe today causing problems with right eye. Had to see a specialist

Release 9 — day 7, dose 2

2021-09-29

Systemic reaction (other): Runny nose, experienced nose bleed this morning. Severe headache causing problems with vision. Menstural cycle lasted more days than normal. Right lymph nodes are swollen

Release 10 — day 14, dose 2

2021-10-06

Symptoms: Kidney inflammation. Headaches are mild. Still running low grade fever and chills

Release 10 — day 21, dose 2

2021-10-15

Symptoms: Severe headaches, nausea and vomiting. Unable to eat most times. Drinking Boost. Nosebleeds. Kidney pain. Remain fatigued.

Release 10 — day 35, dose 2

2021-10-27

Symptoms: Dizziness, body aches, runny nose , headaches low blood pressure

Release 10 — day 42, dose 2

2021-11-04

Symptoms: Continue fatigue. Loss of appetite and weight loss. Headaches continue. Dizziness, earache, swollen lymph node.

Release 10 — 3 months, dose 2

2021-12-25

Symptoms: Nausea and cluster headaches are back. Bruising occurring to b/l Lower extremities. Off balance. Runny nose and sore throat. No energy

Release 11 — day 7, dose 3

2022-02-22

Systemic reaction (other): Loss of appetite,

Release 11 — day 14, dose 3

2022-02-23

Symptoms: Lymph nodes swollen. Runny nose slight headache

Release 11 — day 21, dose 3

2022-03-02

Symptoms: Bruising and rash to lower right leg, swollen glands moderate pain, soreness at injection site, fatigue

Release 11 — day 28, dose 3

2022-03-10

Symptoms: Pain at side of neck. Glands swollen. More bruising to lower extremities. Fatigue and runny nose

Release 11 — 3 months, dose 3

2022-05-11

Symptoms: Some memory loss /stutter sometimes while talking. Continue to experience fatigue

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	Amnesia	·	·	✓
SD	Asthenia	·	·	✓
SD	Balance disorder	·	·	✓
SD	Chills	·	·	✓
SD	Cluster headache	·	·	✓
SD	Contusion	·	·	✓
SD	Coordination abnormal	·	·	✓
SD	Decreased appetite	·	·	✓
SD	Dizziness	·	·	✓
SD	Dysphemia	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Ear pain	·	·	✓
SD	Epistaxis	·	·	✓
SD	Fall	·	·	✓
SD	Fatigue	·	·	✓
SD	Feeding disorder	·	·	✓
SD	Headache	·	·	✓
SD	Hypotension	·	·	✓
SD	Injection site pain	·	·	✓
SD	Injection site reaction	·	·	✓
SD	Lymphadenopathy	·	·	✓
SD	Nausea	·	·	✓
SD	Neck pain	·	·	✓
SD	Nephritis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rash	·	·	✓
SD	Renal pain	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Thermal burn	·	·	✓
SD	Vomiting	·	·	✓
SD	Weight decreased	·	·	✓
SRO	Abdominal pain upper	·	·	✓
SRO	Abnormal menstrual clots	·	·	✓
SRO	Arthralgia	✓	·	✓
SRO	Chest pain	✓	·	✓
SRO	Chills	·	·	✓
SRO	Decreased appetite	·	·	✓
SRO	Diarrhoea	·	·	✓
SRO	Dyspnoea	✓	·	✓
SRO	Epistaxis	·	·	✓
SRO	Eye disorder	·	·	✓
SRO	Headache	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Menstruation irregular	·	·	✓
SRO	Office visit	·	·	✓
SRO	Oligomenorrhoea	·	·	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Rash	✓	·	✓
SRO	Rash pruritic	✓	·	✓
SRO	Rhinorrhoea	·	·	✓
SRO	Visual impairment	·	·	✓

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