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42R-31678-85898

2 vaccinations 4 coded responses 5 check-ins 4 free-text entries 3 call cases
Sex
Male
Age at first dose
66+
ZIP prefix
329 / FL
Registered
2021-04-01
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-07
    Dose 1 — Moderna
  2. 2021-03-07
    Dose 2 — Moderna
  3. 2021-04-01
    Registered in v-safe
  4. 2021-04-05
    Survey response — day 28, dose 2
    MedDRA: Chest pain, Drug hypersensitivity, Dry skin, Flushing, Food allergy, Headache, Tinnitus — 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
    Free text: After second shot on 7 mar 2021, AFIB x 24 hrs followed by severe chest pains x 1 day, skin flushed and dry all over body, allergic reactions to my meds and certain foods, severe never ending tinnitis, bad headaches.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-04-05
    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)
  6. 2021-04-11
    Survey response — day 35, dose 2
    MedDRA: Flushing, Skin burning sensation — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Flushed and burning skin
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-04-19
    Health check-in — day 42, dose 2
    Feeling: Fair
    Adult check-in
  8. 2021-06-06
    Survey response — 3 months, dose 2
    MedDRA: Blood pressure increased, Heart rate increased — 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
    Free text: Heart rate and bp remain elevated since 2d moderna shot 7 march.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-06-06
    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)
  10. 2021-08-15
  11. 2022-03-07
    Survey response — 12 months, dose 2
    MedDRA: Arthralgia, Atrial fibrillation, Chest pain, Cough, Device ineffective, Dizziness, Headache, Immediate post-injection reaction, Joint swelling, Palpitations — Feeling: Poor · 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: Uncontrolled AFI B. Uncontrolled by pacemaker high ventricular rate. Chest pains. Racing heart. Headaches constant cough lightheadedness swollen painful ankles . These symptoms started immediately after the 2nd moderna vaccination March 2021
    MedDRA releases: 2024-11 · check-in free text available
  12. 2022-03-07
    Report sent to call center — 12 months, dose 2
    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 · 1 call case(s)
  13. 2022-03-08
    Call successful
    Participant prefers to complete VAERS report online

Vaccinations

DoseDateManufacturerCo-administered
12021-02-07Moderna
22021-03-07Moderna

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 6 — day 28, dose 2

2021-04-05

Symptoms: After second shot on 7 mar 2021, AFIB x 24 hrs followed by severe chest pains x 1 day, skin flushed and dry all over body, allergic reactions to my meds and certain foods, severe never ending tinnitis, bad headaches.

Release 7 — day 35, dose 2

2021-04-11

Symptoms: Flushed and burning skin

Release 8 — 3 months, dose 2

2021-06-06

Symptoms: Heart rate and bp remain elevated since 2d moderna shot 7 march.

Release 11 — 12 months, dose 2

2022-03-07

Symptoms: Uncontrolled AFI B. Uncontrolled by pacemaker high ventricular rate. Chest pains. Racing heart. Headaches constant cough lightheadedness swollen painful ankles . These symptoms started immediately after the 2nd moderna vaccination March 2021

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
SDArthralgia · · ✓
SDAtrial fibrillation · · ✓
SDBlood pressure increased ✓ ✓ ✓
SDChest pain ✓ ✓ ✓
SDCough · · ✓
SDDevice ineffective · · ✓
SDDizziness · · ✓
SDDrug hypersensitivity ✓ ✓ ✓
SDDry skin ✓ ✓ ✓
SDFlushing ✓ ✓ ✓
SDFood allergy ✓ ✓ ✓
SDHeadache ✓ ✓ ✓
SDHeart rate increased ✓ ✓ ✓
SDImmediate post-injection reaction · · ✓
SDJoint swelling · · ✓
SDPalpitations · · ✓
SDSkin burning sensation ✓ ✓ ✓
SDTinnitus ✓ ✓ ✓

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