6KA-31290-04838

3 vaccinations 10 coded responses 16 check-ins 10 free-text entries 7 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 904 / CA
Registered: 2021-10-25

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-02-05
Dose 1 — Moderna
2021-03-05
Dose 2 — Moderna
2021-10-25
Registered in v-safe
2021-10-25
Dose 3 — Moderna
2021-10-25
Survey response — day 0, dose 3
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness

Free text: Relief!

MedDRA releases: 2024-11 · check-in free text available
2021-10-26
Survey response — days 1–6 daily, dose 3
MedDRA: Atrial fibrillation, Emergency care, Hospitalisation, Palpitations — Feeling: Poor · Chills, Headache, Muscle or body aches, Fatigue or tiredness · 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: Systemic reaction (other): Onset of Afib. I'm in the ER. Also my heart has been racing for hours. It's serious. · Healthcare visit (other): I'm being admitted to (b)(6) Center.

MedDRA releases: 2024-11 · check-in free text available
2021-10-26
Report sent to call center — days 1–6 daily, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: Atrial fibrillation, Hospitalisation — Feeling: Poor · Site: Swelling, Itching · Headache · 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: I'm hospitalized dealing with what has become constant Afib, maybe brought on, but at least triggered by my Moderna booster Monday morning.

MedDRA releases: 2024-11 · check-in free text available
2021-10-27
Report sent to call center — days 1–6 daily, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-10-27
Call 1 — Left Voicemail
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Atrial fibrillation, Surgery — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Surgical procedure to correct Afib possibly caused by Moderna booster

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-10-28
Call 1 — Left Voicemail
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-29
Call successful
Participant prefers to complete VAERS report online
2021-10-29
Call successful
Participant prefers to complete VAERS report online
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-01
Survey response — day 7, dose 3
MedDRA: Atrial fibrillation, Immunisation reaction — Feeling: Good

Free text: Afib returned for 2hrs last night. Also, more importantly, I filled out a complete report re: my negative reaction to the booster, but the form didn't let me put in my age, nor the hospital test results. I requested a phone call to fill in the blanks

MedDRA releases: 2024-11 · check-in free text available
2021-11-10
Survey response — day 14, dose 3
MedDRA: Atrial fibrillation, Office visit, Weight decreased — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Afib and weight loss continue. I'm now forced to take 4 different meds that were not in my life before the booster shot: Metoprolol, Eliquis, Famotidine, and Ranexa. · Healthcare visit (other): Post hospital cardiologist and GP visits and lab tests.

MedDRA releases: 2024-11 · check-in free text available
2021-11-10
Report sent to call center — day 14, dose 3
Get care from a doctor or other healthcare professional

no matching call case
2021-11-15
Survey response — day 21, dose 3
MedDRA: Atrial fibrillation, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Afib is again nearly constant. I'll likely have cardiac ablation in the next few days in the hope of stopping it. Again, I attribute the Afib as a negative side effect of my Moderna booster 3 wks ago. · Healthcare visit (other): Thorough exams and blood tests at both GP and Cardiologist offices.

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Report sent to call center — day 21, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-16
Call 1 — Left Voicemail
2021-11-22
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-29
Survey response — day 35, dose 3
MedDRA: Atrial fibrillation, Office visit, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Afib returned. I will need a surgical procedure called Ablation. For now I'm taking meds to alleviate the Afib, which saps my energy, sense of balance, and visual acuity up close; I need reading glasses. · Healthcare visit (other): Doctor office visit.

MedDRA releases: 2024-11 · check-in free text available
2021-11-29
Report sent to call center — day 35, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-06
Survey response — day 42, dose 3
MedDRA: Atrial fibrillation, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Afib came back. The drugs are working to control it, but this past week has been all about Ablation education. Gonna have that procedure. · Healthcare visit (other): Office consult; ECG and other tests.

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-07
Call 1 — Left Voicemail
2022-01-24
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-25
Survey response — 6 months, dose 3
MedDRA: Atrial fibrillation, Cardiac ablation, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: Afib, until having an Ablation procedure March 3. · Healthcare visit (other): See above.

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-05-03
Call 1 — Left Voicemail
2022-10-25
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna	No
2	2021-03-05	Moderna	No
3	2021-10-25	Moderna	No

Call center

7 call center cases

3 successful · 4 unsuccessful

VAERS report filed, before or during a call: 1

1 check-in flagged for a call with no call center case on record

See the call center timeline

Free text

Release 10 — day 0, dose 3

2021-10-25

Systemic reaction (other): Relief!

Release 10 — days 1–6 daily, dose 3

2021-10-26

Systemic reaction (other): Onset of Afib. I'm in the ER. Also my heart has been racing for hours. It's serious.

Healthcare visit (other): I'm being admitted to (b)(6) Center.

redacted (b)(6)

2021-10-27

Systemic reaction (other): I'm hospitalized dealing with what has become constant Afib, maybe brought on, but at least triggered by my Moderna booster Monday morning.

2021-10-28

Systemic reaction (other): Surgical procedure to correct Afib possibly caused by Moderna booster

Release 10 — day 7, dose 3

2021-11-01

Systemic reaction (other): Afib returned for 2hrs last night. Also, more importantly, I filled out a complete report re: my negative reaction to the booster, but the form didn't let me put in my age, nor the hospital test results. I requested a phone call to fill in the blanks cut off by CDC

Release 10 — day 14, dose 3

2021-11-10

Symptoms: Afib and weight loss continue. I'm now forced to take 4 different meds that were not in my life before the booster shot: Metoprolol, Eliquis, Famotidine, and Ranexa.

Healthcare visit (other): Post hospital cardiologist and GP visits and lab tests.

Release 10 — day 21, dose 3

2021-11-15

Symptoms: Afib is again nearly constant. I'll likely have cardiac ablation in the next few days in the hope of stopping it. Again, I attribute the Afib as a negative side effect of my Moderna booster 3 wks ago.

Healthcare visit (other): Thorough exams and blood tests at both GP and Cardiologist offices.

Release 10 — day 35, dose 3

2021-11-29

Symptoms: Afib returned. I will need a surgical procedure called Ablation. For now I'm taking meds to alleviate the Afib, which saps my energy, sense of balance, and visual acuity up close; I need reading glasses.

Healthcare visit (other): Doctor office visit.

Release 10 — day 42, dose 3

2021-12-06

Symptoms: Afib came back. The drugs are working to control it, but this past week has been all about Ablation education. Gonna have that procedure.

Healthcare visit (other): Office consult; ECG and other tests.

Release 11 — 6 months, dose 3

2022-04-25

Symptoms: Afib, until having an Ablation procedure March 3.

Healthcare visit (other): See above.

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	Hospitalisation	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Atrial fibrillation	·	·	✓
SD	Cardiac ablation	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Weight decreased	·	·	✓
SRO	Atrial fibrillation	·	·	✓
SRO	Emergency care	·	·	✓
SRO	Hospitalisation	·	·	✓
SRO	Immunisation reaction	·	·	✓
SRO	No adverse event	·	·	✓
SRO	Palpitations	·	·	✓
SRO	Surgery	·	·	✓

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