3AF-26995-27272
4 vaccinations
4 coded responses
49 check-ins
4 free-text entries
4 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 201 / VA
- Registered
- 2021-02-28
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-28
Registered in v-safe
-
2021-02-28
Dose 1 — Moderna
- 2021-02-28
-
2021-03-01
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-05
- 2021-03-06
- 2021-03-07
- 2021-03-14
- 2021-03-21
- 2021-03-28
-
2021-03-30
Dose 2 — Moderna
- 2021-03-30
- 2021-03-31
- 2021-04-01
- 2021-04-02
- 2021-04-03
- 2021-04-04
- 2021-04-05
- 2021-04-06
- 2021-04-13
- 2021-04-22
- 2021-04-27
- 2021-05-04
- 2021-05-11
- 2021-06-29
-
2021-08-16
Dose 3 — Moderna
- 2021-08-16
-
2021-08-17
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-08-18
- 2021-08-19
-
2021-08-20
Survey response — days 1–6 daily, dose 3MedDRA: Chest discomfort, Medical counselling, Office visit, Supraventricular tachycardia — Feeling: Fair · Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Systemic reaction (other): Chest tightness, SVT took x2 Nitrostat called Cardiologist · Healthcare visit (other): Called Cardiologist to report chest tightness SVT took x2 NitrostatMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-20
Report sent to call center — days 1–6 daily, dose 3Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-21
- 2021-08-22
- 2021-08-23
-
2021-08-27
Call successfulParticipant prefers to complete VAERS report online
-
2021-08-30
Survey response — day 14, dose 3MedDRA: Atrial flutter, Cardioversion, Emergency care, Hospitalisation — 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, Emergency room or emergency department visit, HospitalizationFree text: Symptoms: New onset Atrial Flutter with rapid ventricular response Thursday Evening & Friday AM. Per Cardiologist went to (b)(6) Hosp ER. Did convert back to NSR with 1stAVB. · Healthcare visit (other): 24hour observation in hospMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-30
Report sent to call center — day 14, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-09-02
Call successfulParticipant prefers to complete VAERS report online
- 2021-09-06
-
2021-09-13
Survey response — day 28, dose 3MedDRA: Office visit, Sinusitis, Upper respiratory tract infection — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Dx by primary MD today Sinus infection & Upper Respiratory Infection. Symptoms started Friday 9/10/21 after starting Zetia 10mg QD Thursday PM. · Healthcare visit (other): Primary MD in personMedDRA releases: 2024-11 · check-in free text available
-
2021-09-13
Report sent to call center — day 28, dose 3Get care from a doctor or other healthcare professional1 call case(s)
-
2021-09-16
Call successfulParticipant prefers to complete VAERS report online
- 2021-09-20
- 2021-09-27
- 2021-11-15
-
2022-02-14
Survey response — 6 months, dose 3MedDRA: Atelectasis, Bronchitis, COVID-19, Hospitalisation, Pneumonia, Pulmonary embolism, Supraventricular tachycardia, Unevaluable event — 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, Emergency room or emergency department visit, HospitalizationFree text: Symptoms: Covid positive 1/21/22 sinus & bronchitis, then bibasilar pneumonia, bibasilar atelectasis, SVT & Bilateral PEs. Hospitalized 2/8-2/11/22 · Healthcare visit (other): 2/8-2/11/22MedDRA releases: 2024-11 · check-in free text available
-
2022-02-14
Report sent to call center — 6 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2022-02-15
Call successfulDoes not wish to fill out VAERS report
-
2022-04-06
Dose 4 — Moderna
- 2022-04-14
- 2022-04-20
- 2022-04-27
- 2022-05-04
- 2022-05-11
- 2022-05-18
- 2022-07-06
- 2022-10-05
- 2023-04-08
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-28 | Moderna | |
| 2 | 2021-03-30 | Moderna | |
| 3 | 2021-08-16 | Moderna | No |
| 4 | 2022-04-06 | Moderna | No |
Call center
4 call center cases
4 successful
Free text
Release 9 — days 1–6 daily, dose 3
Systemic reaction (other): Chest tightness, SVT took x2 Nitrostat called Cardiologist
Healthcare visit (other): Called Cardiologist to report chest tightness SVT took x2 Nitrostat
Release 9 — day 14, dose 3
Symptoms: New onset Atrial Flutter with rapid ventricular response Thursday Evening & Friday AM. Per Cardiologist went to (b)(6) Hosp ER. Did convert back to NSR with 1stAVB.
Healthcare visit (other): 24hour observation in hosp
redacted (b)(6)
Release 9 — day 28, dose 3
Symptoms: Dx by primary MD today Sinus infection & Upper Respiratory Infection. Symptoms started Friday 9/10/21 after starting Zetia 10mg QD Thursday PM.
Healthcare visit (other): Primary MD in person
Release 11 — 6 months, dose 3
Symptoms: Covid positive 1/21/22 sinus & bronchitis, then bibasilar pneumonia, bibasilar atelectasis, SVT & Bilateral PEs. Hospitalized 2/8-2/11/22
Healthcare visit (other): 2/8-2/11/22
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 | Chest discomfort | ✓ | · | ✓ |
| HCVO | Hospitalisation | ✓ | · | ✓ |
| HCVO | Office visit | ✓ | · | ✓ |
| HCVO | Supraventricular tachycardia | ✓ | · | ✓ |
| HCVO | Unevaluable event | · | · | ✓ |
| SD | Atelectasis | · | · | ✓ |
| SD | Atrial flutter | ✓ | · | ✓ |
| SD | Bronchitis | · | · | ✓ |
| SD | Cardioversion | ✓ | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Emergency care | ✓ | · | ✓ |
| SD | Hospitalisation | · | · | ✓ |
| SD | Pneumonia | · | · | ✓ |
| SD | Pulmonary embolism | · | · | ✓ |
| SD | Sinusitis | · | · | ✓ |
| SD | Supraventricular tachycardia | · | · | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SD | Upper respiratory tract infection | · | · | ✓ |
| SRO | Chest discomfort | ✓ | · | ✓ |
| SRO | Medical counselling | ✓ | · | ✓ |
| SRO | Supraventricular tachycardia | ✓ | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release