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3TS-17173-94254

4 vaccinations 5 coded responses 15 check-ins 5 free-text entries 3 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
947 / CA
Registered
2021-02-27
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-12
    Dose 1 — Moderna
  2. 2021-02-27
    Registered in v-safe
  3. 2021-02-27
    Survey response — day 14, dose 1
    MedDRA: Atrial fibrillation, Cardiac flutter, Emergency care, Mobility decreased — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit
    Free text: This is my first check in. The evening of my test I had a fluttering heart and went to bed early. Two evenings later I went to ER and stayed overnight, I was diagnosed with a fib. I now have a cardiologist. She says this condition not fm the Vaccine
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-02-27
    Report sent to call center — day 14, dose 1
    Get care from a doctor or other healthcare professional
    1 call case(s)
  5. 2021-03-12
    Dose 2 — Moderna
  6. 2021-03-14
    Survey response — days 1–6 daily, dose 2
    MedDRA: Heart rate increased — Feeling: Fair · Site: Pain · Fatigue or tiredness
    Free text: Heart rate was unusually high yesterday with no activity
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-06-13
    Survey response — 3 months, dose 2
    MedDRA: Atrial fibrillation — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit
    Free text: Atrial Fibralation event 2 days after 1 st vaccination and another one 7 days ago
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-06-13
    Report sent to call center — 3 months, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  9. 2021-06-22
  10. 2021-06-25
  11. 2021-06-25
  12. 2021-09-11
    Survey response — 6 months, dose 2
    MedDRA: Bradycardia, Cardiac pacemaker insertion, Heart rate decreased — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization
    Free text: Symptoms: Brady Kardia, very low heart rate. · Healthcare visit (other): Surgery to implant a Pacemaker
    MedDRA releases: 2024-11 · check-in free text available
  13. 2021-09-11
    Report sent to call center — 6 months, dose 2
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  14. 2021-09-14
  15. 2021-09-22
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  16. 2021-10-22
    Dose 3 — Moderna
  17. 2021-10-28
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  18. 2021-10-29
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  19. 2021-11-05
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  20. 2021-11-14
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  21. 2021-11-21
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  22. 2021-12-05
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  23. 2022-01-22
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  24. 2022-04-04
    Dose 4 — Moderna
  25. 2022-04-14
    Health check-in — day 7, dose 4
    Feeling: Good · None
    Adult check-in
  26. 2022-04-18
    Health check-in — day 14, dose 4
    Feeling: Good
    Adult check-in
  27. 2022-04-26
    Health check-in — day 21, dose 4
    Feeling: Good
    Adult check-in
  28. 2022-05-04
    Survey response — day 28, dose 4
    MedDRA: Cough, Sneezing, Upper-airway cough syndrome — Feeling: Good
    Free text: Post nasal drip and sneezing and some cough
    MedDRA releases: 2024-11 · check-in free text available

Vaccinations

DoseDateManufacturerCo-administered
12021-02-12Moderna
22021-03-12Moderna
32021-10-22Moderna No
42022-04-04Moderna No

Call center

3 call center cases

1 successful · 2 unsuccessful

See the call center timeline

Free text

Release 4 — day 14, dose 1

2021-02-27

Symptoms: This is my first check in. The evening of my test I had a fluttering heart and went to bed early. Two evenings later I went to ER and stayed overnight, I was diagnosed with a fib. I now have a cardiologist. She says this condition not fm the Vaccine cut off by CDC

Release 5 — days 1–6 daily, dose 2

2021-03-14

Systemic reaction (other): Heart rate was unusually high yesterday with no activity

Release 9 — 3 months, dose 2

2021-06-13

Symptoms: Atrial Fibralation event 2 days after 1 st vaccination and another one 7 days ago

Release 9 — 6 months, dose 2

2021-09-11

Symptoms: Brady Kardia, very low heart rate.
Healthcare visit (other): Surgery to implant a Pacemaker

Release 11 — day 28, dose 4

2022-05-04

Symptoms: Post nasal drip and sneezing and some cough

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
HCVOCardiac pacemaker insertion · · ✓
SDAtrial fibrillation ✓ ✓ ✓
SDBradycardia · · ✓
SDCardiac flutter ✓ ✓ ✓
SDCough · · ✓
SDEmergency care ✓ ✓ ✓
SDHeart rate decreased · · ✓
SDMobility decreased ✓ ✓ ✓
SDSneezing · · ✓
SDUpper-airway cough syndrome · · ✓
SROHeart rate increased ✓ ✓ ✓

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

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