53C-29000-08763
1 vaccination
3 coded responses
15 check-ins
3 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 324 / FL
- Registered
- 2021-02-17
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-02-17
Registered in v-safe
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2021-02-17
Dose 1 — Moderna
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2021-02-17
Survey response — day 0, dose 1MedDRA: Injection site pain — Feeling: Good · Fatigue or tirednessFree text: slightly sore at injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-18
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
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2021-02-19
Survey response — days 1–6 daily, dose 1MedDRA: Atrial fibrillation, Pre-existing disease — Feeling: Good · Site: Pain · Muscle or body aches · 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: Last night, 36 hours after the first dose I had atrial fibrillation. This is the first time in over two years. Can't say for sure that the vaccine is the reason but it sure seems like it. The event lasted about 3 hours. There have not been any other significant events. Not certain at this point whether I will get the second dose. I feel Ok now.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-19
Report sent to call center — days 1–6 daily, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-02-20
- 2021-02-21
- 2021-02-22
- 2021-02-23
- 2021-02-24
- 2021-03-03
- 2021-03-10
- 2021-03-17
- 2021-03-24
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2021-03-31
Survey response — day 42, dose 1MedDRA: Specialist consultation, Ventricular extrasystoles — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Having SVEs and PVCs with more frequency. Didn't have thise before the first vaccine shot. For that reason will not be taking the second shot in the near future. · Healthcare visit (other): Went to see my primary care physician and also cardiologist.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-31
Report sent to call center — day 42, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-05-20
- 2021-08-10
- 2021-08-19
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-17 | Moderna |
Call center
2 call center cases
2 unsuccessful
1 wait over 3 months for a first call
Free text
Release 4 — day 0, dose 1
Systemic reaction (other): slightly sore at injection site
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Last night, 36 hours after the first dose I had atrial fibrillation. This is the first time in over two years. Can't say for sure that the vaccine is the reason but it sure seems like it. The event lasted about 3 hours. There have not been any other significant events. Not certain at this point whether I will get the second dose. I feel Ok now.
Release 6 — day 42, dose 1
Symptoms: Having SVEs and PVCs with more frequency. Didn't have thise before the first vaccine shot. For that reason will not be taking the second shot in the near future.
Healthcare visit (other): Went to see my primary care physician and also cardiologist.
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 | Specialist consultation | ✓ | ✓ | ✓ |
| SD | Ventricular extrasystoles | ✓ | ✓ | ✓ |
| SRO | Atrial fibrillation | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release