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3JM-17255-32784

4 vaccinations 4 coded responses 14 check-ins 4 free-text entries 1 call case
Sex
Male
Age at first dose
66+
ZIP prefix
935 / CA
Registered
2021-02-09
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-04
    Dose 1 — Pfizer-BioNTech
  2. 2021-02-09
    Registered in v-safe
  3. 2021-02-09
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · None
    Adult check-in
  4. 2021-02-10
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  5. 2021-02-11
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-02-18
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  7. 2021-02-20
    Dose 2 — Pfizer-BioNTech
  8. 2021-02-25
    Survey response — days 1–6 daily, dose 2
    MedDRA: Atrial fibrillation, Fatigue — Feeling: Poor · Fever · Fatigue or tiredness · Be unable to work
    Free text: 12hrs after 2nd vaccine on Feb 20, 2021, extreme uncontrolled atrial fribulation and severe fatigue.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-02-26
    Survey response — days 1–6 daily, dose 2
    MedDRA: Atrial fibrillation, Fatigue, Pre-existing disease — Feeling: Fair · Fever · Fatigue or tiredness · Be unable to do your normal daily activities
    Free text: Declining atrial fribulation, rapid heart beat, BPM; 115. Fatigue
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-02-27
    Survey response — day 7, dose 2
    MedDRA: Arrhythmia, Atrial fibrillation, Fatigue, Heart rate increased — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities
    Free text: Arithmias, atrial fribulation, raprid heart rate. Fatigue
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-03-09
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  12. 2021-03-14
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  13. 2021-03-22
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  14. 2021-03-27
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  15. 2021-04-03
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  16. 2021-05-24
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-08-26
    Survey response — 6 months, dose 2
    MedDRA: Atrial fibrillation, Myocardial injury, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation
    Free text: Symptoms: Severe atrial fribulation since second vacine. On Elequis blood thinner....permanently. Looks like the vaccine caused permanent cardiac damage. I am being evaluated for the Watchman procedure. · Healthcare visit (other): Regular Drs appointments
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  18. 2021-08-26
    Report sent to call center — 6 months, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  19. 2021-11-24
    Dose 3 — Pfizer-BioNTech
  20. 2021-12-13
    Call successful
    Participant prefers to complete VAERS report online
  21. 2022-09-08
    Dose 4 — Moderna
    Co-administered: Shingles

Vaccinations

DoseDateManufacturerCo-administered
12021-02-04Pfizer-BioNTech
22021-02-20Pfizer-BioNTech
32021-11-24Pfizer-BioNTech No
42022-09-08Moderna Shingles

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-25

Systemic reaction (other): 12hrs after 2nd vaccine on Feb 20, 2021, extreme uncontrolled atrial fribulation and severe fatigue.

2021-02-26

Systemic reaction (other): Declining atrial fribulation, rapid heart beat, BPM; 115. Fatigue

Release 4 — day 7, dose 2

2021-02-27

Systemic reaction (other): Arithmias, atrial fribulation, raprid heart rate. Fatigue

Release 9 — 6 months, dose 2

2021-08-26

Symptoms: Severe atrial fribulation since second vacine. On Elequis blood thinner....permanently. Looks like the vaccine caused permanent cardiac damage. I am being evaluated for the Watchman procedure.
Healthcare visit (other): Regular Drs appointments

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

FieldPreferred term2021-092023-042024-11
HCVOOffice visit ✓ · ✓
SDAtrial fibrillation ✓ · ✓
SDMyocardial injury ✓ · ✓
SROArrhythmia ✓ ✓ ✓
SROAtrial fibrillation ✓ ✓ ✓
SROFatigue ✓ ✓ ✓
SROHeart rate increased ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓

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