ZG4-38012-13205

3 vaccinations 12 coded responses 29 check-ins 11 free-text entries 4 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 010 / MA
Registered: 2021-04-25

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

2021-04-22
Dose 1 — Pfizer-BioNTech
2021-04-25
Registered in v-safe
2021-04-25
Survey response — days 1–6 daily, dose 1
MedDRA: Respiratory tract congestion — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-29
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-05-07
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-14
Dose 2 — Pfizer-BioNTech
2021-05-14
Survey response — day 21, dose 1
MedDRA: Hypersomnia, Petechiae, Skin discolouration — Feeling: Fair

Free text: White smooth patches on skin, and more petechiae, also extra sleeping. This has been going on since May3rd.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-21
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-28
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-05
Survey response — day 21, dose 2
MedDRA: Vitreous floaters — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Floaters in eyes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-05
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-18
Survey response — day 35, dose 2
MedDRA: Visual impairment — Feeling: Good

Free text: Black lines and spots in both eyes.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-25
Survey response — day 42, dose 2
MedDRA: Blood urine, Blood urine present, Visual impairment — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Black spots and lines in my vision - seeing them in both eyes. Also, trace blood in urine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-25
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-01
Call successful
Participant prefers to complete VAERS report online
2021-08-13
Survey response — 3 months, dose 2
MedDRA: Office visit, Visual impairment, Vitreous floaters — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: My vision continues to be problematic since two weeks after my second vaccine. I am seeing lots of odd shapes in both eyes. · Healthcare visit (other): Multiple eye appointments

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-13
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-18
Call 1 — Left Voicemail
2021-08-23
Call 2 — Left Voicemail
2021-11-14
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-01-07
Dose 3 — Moderna
2022-01-07
Survey response — day 0, dose 3
MedDRA: Visual impairment — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: I am still having vision problems since two weeks after my second COVID vaccine.

MedDRA releases: 2024-11 · check-in free text available
2022-01-08
Survey response — days 1–6 daily, dose 3
MedDRA: Visual impairment — Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness

Free text: I still have vision problems from 2 weeks after my second Pfizer vaccine

MedDRA releases: 2024-11 · check-in free text available
2022-01-09
Survey response — days 1–6 daily, dose 3
MedDRA: Visual impairment — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: I still have vision problems from two weeks after my second Pfizer vaccine

MedDRA releases: 2024-11 · check-in free text available
2022-01-11
Survey response — days 1–6 daily, dose 3
MedDRA: Visual impairment — Feeling: Fair · Chills, Fatigue or tiredness

Free text: I have had vision problems since two weeks after my second Pfizer vaccine

MedDRA releases: 2024-11 · check-in free text available
2022-01-12
Survey response — days 1–6 daily, dose 3
MedDRA: Visual impairment — Feeling: Fair · Fatigue or tiredness

Free text: I still have vision problems from 2 weeks after my second Pfizer dose last May.

MedDRA releases: 2024-11 · check-in free text available
2022-01-13
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Fatigue or tiredness, Abdominal pain

Adult check-in
2022-01-14
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-01-21
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-01-28
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-02-04
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-11
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-02-18
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-04-08
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-07-08
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2023-01-07
Survey response — 12 months, dose 3
MedDRA: Alopecia — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-01-07
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-01-10
Call successful
Does not wish to fill out VAERS report
2023-01-10
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-22	Pfizer-BioNTech
2	2021-05-14	Pfizer-BioNTech
3	2022-01-07	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-06-05	Successful	Participant prefers to complete VAERS report online
2021-06-25	Successful 2021-07-01	Participant prefers to complete VAERS report online
2021-08-13	Successful 2023-01-10	Does not wish to fill out VAERS report
2023-01-07	Successful 2023-01-10	Participant prefers to complete VAERS report online

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-25

Systemic reaction (other): Congestion

Release 8 — day 21, dose 1

2021-05-14

Symptoms: White smooth patches on skin, and more petechiae, also extra sleeping. This has been going on since May3rd.

Release 8 — day 21, dose 2

2021-06-05

Symptoms: Floaters in eyes

Release 9 — day 35, dose 2

2021-06-18

Symptoms: Black lines and spots in both eyes.

Release 9 — day 42, dose 2

2021-06-25

Symptoms: Black spots and lines in my vision - seeing them in both eyes. Also, trace blood in urine.

Release 9 — 3 months, dose 2

2021-08-13

Symptoms: My vision continues to be problematic since two weeks after my second vaccine. I am seeing lots of odd shapes in both eyes.

Healthcare visit (other): Multiple eye appointments

Release 10 — day 0, dose 3

2022-01-07

Systemic reaction (other): I am still having vision problems since two weeks after my second COVID vaccine.

Release 10 — days 1–6 daily, dose 3

2022-01-08

Systemic reaction (other): I still have vision problems from 2 weeks after my second Pfizer vaccine

2022-01-09

Systemic reaction (other): I still have vision problems from two weeks after my second Pfizer vaccine

2022-01-11

Systemic reaction (other): I have had vision problems since two weeks after my second Pfizer vaccine

2022-01-12

Systemic reaction (other): I still have vision problems from 2 weeks after my second Pfizer dose last May.

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	✓	·	✓
SD	Alopecia	·	·	✓
SD	Blood urine	✓	✓	○
SD	Blood urine present	·	·	✓
SD	Hypersomnia	✓	✓	✓
SD	Petechiae	✓	✓	✓
SD	Skin discolouration	✓	✓	✓
SD	Visual impairment	✓	✓	✓
SD	Vitreous floaters	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Visual impairment	·	·	✓

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