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
-
2021-02-04
Dose 1 — Pfizer-BioNTech
-
2021-02-09
Registered in v-safe
- 2021-02-09
- 2021-02-10
- 2021-02-11
- 2021-02-18
-
2021-02-20
Dose 2 — Pfizer-BioNTech
-
2021-02-25
Survey response — days 1–6 daily, dose 2MedDRA: Atrial fibrillation, Fatigue — Feeling: Poor · Fever · Fatigue or tiredness · Be unable to workFree 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
-
2021-02-26
Survey response — days 1–6 daily, dose 2MedDRA: Atrial fibrillation, Fatigue, Pre-existing disease — Feeling: Fair · Fever · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Declining atrial fribulation, rapid heart beat, BPM; 115. FatigueMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-27
Survey response — day 7, dose 2MedDRA: Arrhythmia, Atrial fibrillation, Fatigue, Heart rate increased — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Arithmias, atrial fribulation, raprid heart rate. FatigueMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-09
- 2021-03-14
- 2021-03-22
- 2021-03-27
- 2021-04-03
- 2021-05-24
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2021-08-26
Survey response — 6 months, dose 2MedDRA: Atrial fibrillation, Myocardial injury, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree 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 appointmentsMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-26
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2021-11-24
Dose 3 — Pfizer-BioNTech
-
2021-12-13
Call successfulParticipant prefers to complete VAERS report online
-
2022-09-08
Dose 4 — ModernaCo-administered: Shingles
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-04 | Pfizer-BioNTech | |
| 2 | 2021-02-20 | Pfizer-BioNTech | |
| 3 | 2021-11-24 | Pfizer-BioNTech | No |
| 4 | 2022-09-08 | Moderna | Shingles |
Call center
1 call center case
1 successful
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): 12hrs after 2nd vaccine on Feb 20, 2021, extreme uncontrolled atrial fribulation and severe fatigue.
Systemic reaction (other): Declining atrial fribulation, rapid heart beat, BPM; 115. Fatigue
Release 4 — day 7, dose 2
Systemic reaction (other): Arithmias, atrial fribulation, raprid heart rate. Fatigue
Release 9 — 6 months, dose 2
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
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| HCVO | Office visit | ✓ | · | ✓ |
| SD | Atrial fibrillation | ✓ | · | ✓ |
| SD | Myocardial injury | ✓ | · | ✓ |
| SRO | Arrhythmia | ✓ | ✓ | ✓ |
| SRO | Atrial fibrillation | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Heart rate increased | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release