ZJ4-12618-75595

4 vaccinations 7 coded responses 41 check-ins 6 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 800 / CO
Registered: 2021-02-19

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

2021-02-19
Registered in v-safe
2021-02-19
Dose 1 — Pfizer-BioNTech
2021-02-19
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-26
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-12
Dose 2 — Pfizer-BioNTech
2021-03-12
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-26
Survey response — day 14, dose 2
MedDRA: Arthralgia, Bone pain, Urinary tract infection — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: UTI, reaction to .4 IV of Zometa on 3/19- bone and joint pain (4th IV -every 6 months; 1st reaction) · Healthcare visit (other): Lab for UTI

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-02
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-16
Survey response — day 35, dose 2
MedDRA: Arthralgia, Back pain, Pre-existing disease — Feeling: Fair

Free text: Joint and back pain (due to side effects of AI medication - Anastrozole for breast cancer treatment).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-11
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Fall, Joint injury — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fell and hurt left knee.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-10
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-08
Dose 3 — Pfizer-BioNTech
2022-01-05
Call 1 — Left Voicemail
2022-03-12
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-04-29
Dose 4 — Pfizer-BioNTech
2022-04-29
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-04-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-05-01
Survey response — days 1–6 daily, dose 4
MedDRA: No adverse event — Feeling: Good · Site: Pain · Diarrhea

Free text: None

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-03
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-04
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-05
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-06
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-13
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-20
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-27
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-03
Survey response — day 35, dose 4
MedDRA: Diarrhoea, Injection site pain, Medical counselling, Pain in extremity — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sudden onset diarrhea. Working with GI staff - think it' s connected to my IBS. Also have R arm pain and ache at injection site and have had since injection administered.&

MedDRA releases: 2024-11 · check-in free text available
2022-06-03
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-12
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-29
Survey response — 3 months, dose 4
MedDRA: Laboratory test abnormal — 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: Tested positive on 7/10/22

MedDRA releases: 2024-11 · check-in free text available
2022-07-29
Report sent to call center — 3 months, dose 4
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)
2022-08-01
Call 1 — Left Voicemail
2022-08-01
Call successful
Participant prefers to complete VAERS report online
2022-10-30
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-29
Survey response — 12 months, dose 4
MedDRA: Neurogenic bladder, Spinal operation, Vertigo — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

MedDRA releases: 2024-11
2023-04-29
Report sent to call center — 12 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2023-05-01
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-19	Pfizer-BioNTech
2	2021-03-12	Pfizer-BioNTech
3	2021-10-08	Pfizer-BioNTech	No
4	2022-04-29	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-26	Successful 2022-06-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-03	Successful 2022-06-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-29	Successful 2022-08-01	Participant prefers to complete VAERS report online
2023-04-29	Unsuccessful

Free text

Release 6 — day 14, dose 2

2021-03-26

Symptoms: UTI, reaction to .4 IV of Zometa on 3/19- bone and joint pain (4th IV -every 6 months; 1st reaction)

Healthcare visit (other): Lab for UTI

Release 7 — day 35, dose 2

2021-04-16

Symptoms: Joint and back pain (due to side effects of AI medication - Anastrozole for breast cancer treatment).

Release 9 — 3 months, dose 2

2021-06-11

Symptoms: Fell and hurt left knee.

Release 11 — days 1–6 daily, dose 4

2022-05-01

Systemic reaction (other): None

Release 11 — day 35, dose 4

2022-06-03

Symptoms: Sudden onset diarrhea. Working with GI staff - think it' s connected to my IBS. Also have R arm pain and ache at injection site and have had since injection administered.&

Release 12 — 3 months, dose 4

2022-07-29

Symptoms: Tested positive on 7/10/22

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	Urinary tract infection	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Bone pain	✓	✓	✓
SD	Diarrhoea	·	·	✓
SD	Fall	·	·	✓
SD	Injection site pain	·	·	✓
SD	Joint injury	·	·	✓
SD	Laboratory test abnormal	·	·	✓
SD	Medical counselling	·	·	✓
SD	Neurogenic bladder	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Spinal operation	·	·	✓
SD	Urinary tract infection	✓	✓	✓
SD	Vertigo	·	·	✓
SRO	No adverse event	·	·	✓

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