3SC-27080-15541

3 vaccinations 14 coded responses 21 check-ins 14 free-text entries 9 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 100 / NY
Registered: 2021-01-17

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

2021-01-17
Registered in v-safe
2021-01-17
Dose 1 — Moderna
2021-01-17
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-02
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-15
Dose 2 — Moderna
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Cardiac flutter — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Heart fluttering

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-18
Survey response — days 1–6 daily, dose 2
MedDRA: Axillary pain, Lymph node pain, Pain, Tenderness — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches

Free text: My armpit and lymph nodes in the armpit on the side where I got the injection hurts so bad that it's difficult to use my arm or put pressure on my elbow - it feels as if I tore a muscle inside my armpit and it hurts to touch.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Axillary pain, Lymph node pain — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: My armpit and lymph nodes in the arm that I received the vaccine still hurts to touch or even move my arm. It feels like I tore my muscles inside my armpit.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Axillary pain, Lymph node pain, Pain in extremity, Pruritus — Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Still have pain in my armpit and lymph nodes and my arm itches really bad. My leg aches as well now, all on the side I had the injection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Survey response — days 1–6 daily, dose 2
MedDRA: Axillary pain, Rash, Urticaria — Feeling: Fair · Site: Pain, Redness, Itching · Muscle or body aches, Fatigue or tiredness

Free text: I have a rash where I received the vaccine on my arm and I now have a rash on the side of my stomach, same side where I got my vaccine - it looks like hives. I also still have the pain in my armpit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-01
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-15
Survey response — day 28, dose 2
MedDRA: Heart rate increased, Palpitations — 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: Heart palpitations and fast heart rate while resting

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-22
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-29
Survey response — day 42, dose 2
MedDRA: Abdominal pain upper, Dizziness, Eosinophil count increased, Heart rate increased, Nausea — Feeling: Poor · Be unable to work, 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: Rapid heart rate, high eosinophils, sharp stomach pains, nausea and dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Report sent to call center — day 42, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-19
Survey response — 3 months, dose 2
MedDRA: Gastrointestinal disorder — 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, Outpatient clinic or urgent care clinic visit

Free text: Intestinal blockage

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-16
Survey response — 6 months, dose 2
MedDRA: Asthenopia, Blepharospasm, Eye movement disorder, Eye pain, Migraine — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Uncontrollable eye twitching and deviation, and eye rolling, eye strain and pain, migraines

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-16
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-08-19
Call 1 — Left Voicemail
2021-09-17
Dose 3 — Moderna
2021-09-20
Call successful
Participant prefers to complete VAERS report online
2021-10-26
Survey response — day 35, dose 3
MedDRA: Atrial fibrillation, Supraventricular tachycardia — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: SVT, afib

MedDRA releases: 2024-11 · check-in free text available
2021-10-26
Report sent to call center — day 35, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-10-27
Call successful
Participant prefers to complete VAERS report online
2021-11-04
Survey response — day 42, dose 3
MedDRA: Atrial flutter, Cardiac ablation, Emergency care, Heart rate increased, Respiratory arrest, Supraventricular tachycardia — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Had worsening svt and Atrial flutter and stopped breathing after the episode lasted over 20 mins at a heart rate over 350. Went to the hospital by ambulance. Had an ablation.

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Report sent to call center — day 42, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-11-08
Call successful
Does not wish to fill out VAERS report
2021-12-17
Survey response — 3 months, dose 3
MedDRA: Atrial fibrillation, Atrial flutter, Supraventricular tachycardia, Unevaluable event — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Afib, flutter, AT, SVT · Healthcare visit (other): Ablation

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-12-20
Call 1 — Left Voicemail
2021-12-20
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-03-18
Survey response — 6 months, dose 3
MedDRA: Cough, Gastrointestinal dilation procedure, Hallucination, visual — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Visual hallucinations and more coughing problems · Healthcare visit (other): Endoflip dilation

MedDRA releases: 2024-11 · check-in free text available
2022-03-18
Report sent to call center — 6 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-21
Call 1 — Requested Callback
2022-03-22
Callback requested for
2022-03-22
Call successful
Does not wish to fill out VAERS report
2022-09-19
Survey response — 12 months, dose 3
MedDRA: Encephalitis autoimmune — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Autoimmune encephalitis

MedDRA releases: 2024-11 · check-in free text available
2022-09-19
Report sent to call center — 12 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-09-20
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-17	Moderna
2	2021-02-15	Moderna
3	2021-09-17	Moderna	No

Call center

9 call center cases

9 successful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-16

Systemic reaction (other): Heart fluttering

2021-02-18

Systemic reaction (other): My armpit and lymph nodes in the armpit on the side where I got the injection hurts so bad that it's difficult to use my arm or put pressure on my elbow - it feels as if I tore a muscle inside my armpit and it hurts to touch.

2021-02-19

Systemic reaction (other): My armpit and lymph nodes in the arm that I received the vaccine still hurts to touch or even move my arm. It feels like I tore my muscles inside my armpit.

2021-02-20

Systemic reaction (other): Still have pain in my armpit and lymph nodes and my arm itches really bad. My leg aches as well now, all on the side I had the injection.

2021-02-21

Systemic reaction (other): I have a rash where I received the vaccine on my arm and I now have a rash on the side of my stomach, same side where I got my vaccine - it looks like hives. I also still have the pain in my armpit

Release 5 — day 28, dose 2

2021-03-15

Symptoms: Heart palpitations and fast heart rate while resting

Release 6 — day 42, dose 2

2021-03-29

Symptoms: Rapid heart rate, high eosinophils, sharp stomach pains, nausea and dizziness

Release 8 — 3 months, dose 2

2021-05-19

Symptoms: Intestinal blockage

Release 9 — 6 months, dose 2

2021-08-16

Symptoms: Uncontrollable eye twitching and deviation, and eye rolling, eye strain and pain, migraines

Release 10 — day 35, dose 3

2021-10-26

Symptoms: SVT, afib

Release 10 — day 42, dose 3

2021-11-04

Symptoms: Had worsening svt and Atrial flutter and stopped breathing after the episode lasted over 20 mins at a heart rate over 350. Went to the hospital by ambulance. Had an ablation.

Release 10 — 3 months, dose 3

2021-12-17

Symptoms: Afib, flutter, AT, SVT

Healthcare visit (other): Ablation

Release 11 — 6 months, dose 3

2022-03-18

Symptoms: Visual hallucinations and more coughing problems

Healthcare visit (other): Endoflip dilation

Release 12 — 12 months, dose 3

2022-09-19

Symptoms: Autoimmune encephalitis

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	Gastrointestinal dilation procedure	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Asthenopia	✓	·	✓
SD	Atrial fibrillation	·	·	✓
SD	Atrial flutter	·	·	✓
SD	Blepharospasm	✓	·	✓
SD	Cardiac ablation	·	·	✓
SD	Cough	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Emergency care	·	·	✓
SD	Encephalitis autoimmune	·	·	✓
SD	Eosinophil count increased	✓	✓	✓
SD	Eye movement disorder	✓	·	✓
SD	Eye pain	✓	·	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Hallucination, visual	·	·	✓
SD	Heart rate increased	✓	✓	✓
SD	Migraine	✓	·	✓
SD	Nausea	✓	✓	✓
SD	Palpitations	✓	✓	✓
SD	Respiratory arrest	·	·	✓
SD	Supraventricular tachycardia	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Axillary pain	✓	✓	✓
SRO	Cardiac flutter	✓	✓	✓
SRO	Lymph node pain	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Tenderness	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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