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55N-31587-76642

1 vaccination 4 coded responses 13 check-ins 4 free-text entries 3 call cases
Sex
Male
Age at first dose
61-65
ZIP prefix
757 / TX
Registered
2021-01-16
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-16
    Registered in v-safe
  2. 2021-01-16
    Dose 1 — Moderna
  3. 2021-01-16
    Health check-in — day 0, dose 1
    Feeling: Good · None
    Adult check-in
  4. 2021-01-17
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities
    Adult check-in
  5. 2021-01-17
    Report sent to call center — days 1–6 daily, dose 1
    Be unable to work · Be unable to do your normal daily activities
    1 call case(s)
  6. 2021-01-19
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain, Swelling · None
    Adult check-in
  7. 2021-01-22
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Itching · None
    Adult check-in
  8. 2021-01-23
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-01-30
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  10. 2021-02-07
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-02-13
    Survey response — day 28, dose 1
    MedDRA: Cough, Dyspnoea, Hospitalisation, Ventricular tachycardia — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities
    Free text: I had Ventriculartackacardia and was in the hospital unable to breath for 2 days, and was unable to get the shot. I got home last night, after my shot appointment. I also have a bad cough.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-02-20
    Survey response — day 35, dose 1
    MedDRA: Atrial fibrillation, Cardioversion, Cough, Hospitalisation, Respiratory distress, Ventricular tachycardia — Feeling: Fair · Be unable to work, 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: Bad cough, ventricular tachacardia, extremely distressed breathing, hospitalized for 2 days, Afib, heart rate 130-140. Got prepped for cardioversion and heart went into normal sinus rhythm. Missed my second vaccine, Was released and went home
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-02-20
    Report sent to call center — day 35, dose 1
    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)
  14. 2021-02-27
    Survey response — day 42, dose 1
    MedDRA: Atrial fibrillation, Cough, Fatigue — Feeling: Fair
    Free text: Increased Afib, lasting for several days at a time, even while on the increased Sotalol medication. When I am in Afib that long, even 1/2 a day, fatigue sets in and I am exhausted.I have also got the cough I had, when I had the covid, that came back.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-04-17
    Health check-in — 3 months, dose 1
    Feeling: Good
    Adult check-in
  16. 2021-07-17
    Survey response — 6 months, dose 1
    MedDRA: Atrial fibrillation, Cardiac operation — Feeling: Good · Get care from a doctor or other healthcare professional · Hospitalization
    Free text: Bad Afib, too much sotolol to function properly. Chose to have a Wolf Minimaze. In 4th week right now following surgery.Doing much better!.
    MedDRA releases: 2024-11 · check-in free text available
  17. 2021-07-17
    Report sent to call center — 6 months, dose 1
    Get care from a doctor or other healthcare professional
    1 call case(s)
  18. 2021-07-21
  19. 2021-07-24
  20. 2022-01-16
    Health check-in — 12 months, dose 1
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-01-16Moderna

Call center

3 call center cases

2 unsuccessful · 1 priority 2/3 (triaged and no follow up)

See the call center timeline

Free text

Release 4 — day 28, dose 1

2021-02-13

Symptoms: I had Ventriculartackacardia and was in the hospital unable to breath for 2 days, and was unable to get the shot. I got home last night, after my shot appointment. I also have a bad cough.

Release 4 — day 35, dose 1

2021-02-20

Symptoms: Bad cough, ventricular tachacardia, extremely distressed breathing, hospitalized for 2 days, Afib, heart rate 130-140. Got prepped for cardioversion and heart went into normal sinus rhythm. Missed my second vaccine, Was released and went home

Release 4 — day 42, dose 1

2021-02-27

Symptoms: Increased Afib, lasting for several days at a time, even while on the increased Sotalol medication. When I am in Afib that long, even 1/2 a day, fatigue sets in and I am exhausted.I have also got the cough I had, when I had the covid, that came back. cut off by CDC

Release 9 — 6 months, dose 1

2021-07-17

Symptoms: Bad Afib, too much sotolol to function properly. Chose to have a Wolf Minimaze. In 4th week right now following surgery.Doing much better!.

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
SDAtrial fibrillation ✓ ✓ ✓
SDCardiac operation · · ✓
SDCardioversion · · ✓
SDCough ✓ ✓ ✓
SDDyspnoea ✓ ✓ ✓
SDFatigue ✓ ✓ ✓
SDHospitalisation ✓ ✓ ✓
SDRespiratory distress ✓ ✓ ✓
SDTachycardia ○ ○ ○
SDVentricular tachycardia ✓ ✓ ✓

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