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
-
2021-02-07
Dose 1 — Moderna
-
2021-03-07
Dose 2 — Moderna
-
2021-04-01
Registered in v-safe
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2021-04-05
Survey response — day 28, dose 2MedDRA: 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 consultationFree 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
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2021-04-05
Report sent to call center — day 28, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-11
Survey response — day 35, dose 2MedDRA: Flushing, Skin burning sensation — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Flushed and burning skinMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-19
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2021-06-06
Survey response — 3 months, dose 2MedDRA: 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 visitFree 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
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2021-06-06
Report sent to call center — 3 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-15
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2022-03-07
Survey response — 12 months, dose 2MedDRA: 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 visitFree 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 2021MedDRA releases: 2024-11 · check-in free text available
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2022-03-07
Report sent to call center — 12 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-03-08
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-07 | Moderna | |
| 2 | 2021-03-07 | Moderna |
Call center
3 call center cases
3 successful
Free text
Release 6 — day 28, dose 2
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
Symptoms: Flushed and burning skin
Release 8 — 3 months, dose 2
Symptoms: Heart rate and bp remain elevated since 2d moderna shot 7 march.
Release 11 — 12 months, dose 2
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
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| SD | Arthralgia | · | · | ✓ |
| SD | Atrial fibrillation | · | · | ✓ |
| SD | Blood pressure increased | ✓ | ✓ | ✓ |
| SD | Chest pain | ✓ | ✓ | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Device ineffective | · | · | ✓ |
| SD | Dizziness | · | · | ✓ |
| SD | Drug hypersensitivity | ✓ | ✓ | ✓ |
| SD | Dry skin | ✓ | ✓ | ✓ |
| SD | Flushing | ✓ | ✓ | ✓ |
| SD | Food allergy | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Heart rate increased | ✓ | ✓ | ✓ |
| SD | Immediate post-injection reaction | · | · | ✓ |
| SD | Joint swelling | · | · | ✓ |
| SD | Palpitations | · | · | ✓ |
| SD | Skin burning sensation | ✓ | ✓ | ✓ |
| SD | Tinnitus | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release