6KE-64862-86360

1 vaccination 10 coded responses 12 check-ins 10 free-text entries 7 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 163 / PA
Registered: 2021-01-15

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

2021-01-13
Dose 1 — Moderna
2021-01-15
Registered in v-safe
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate increased, Thirst — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, 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: Increased heart rate. Increased thirst

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Report sent to call center — days 1–6 daily, 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)
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate increased — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Elevated heart rate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
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)
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Joint pains, Fatigue or tiredness, Nausea

Adult check-in
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Thirst — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Still thirsty

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-20
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-01-27
Survey response — day 14, dose 1
MedDRA: Adverse reaction, Heart rate increased — Feeling: Fair · Be unable to work, 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: Symptoms: Had to go on s beta blocker due to heart rate issues · Healthcare visit (other): HR was 166

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — day 14, 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)
2021-02-03
Survey response — day 21, dose 1
MedDRA: Anxiety, Fatigue, Headache — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Tired, headache. Anxious

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — day 28, dose 1
MedDRA: Electrocardiogram abnormal, Unevaluable event — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Symptoms: Had ekg with irregularities · Healthcare visit (other): Outpatient tests on multiple days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Report sent to call center — day 28, 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)
2021-02-17
Survey response — day 35, dose 1
MedDRA: Blood pressure increased, Heart rate increased, Hospitalisation — Feeling: Poor · 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: Hospitalized since 2/14/21 due to increase HR and BP, which began after the first shot. I began medication metoprolol 25 mg to help on 1/21 and an increase on 2/5 to 50 mg. I just finished my 5th iv fluid bag.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
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)
2021-02-24
Survey response — day 42, dose 1
MedDRA: Adverse reaction, Hospitalisation, Pre-existing disease, Unevaluable event — Feeling: Poor · Be unable to work, 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, Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Hospitalization with heart issues. Appointment with cardiologist in neighboring city tomorrow. I was instructed by my team of doctos to not get the second shot due to all these symptoms occurring aftwr the first. · Healthcare visit (other): Specialist appoimtments

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Report sent to call center — day 42, 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)
2021-03-12
Call successful
Participant prefers to complete VAERS report online
2021-07-14
Survey response — 6 months, dose 1
MedDRA: Immunisation reaction — Feeling: Poor · Be unable to work or attend school, 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, Emergency room or emergency department visit, Hospitalization

Free text: First react was vac going in L arm, it felt like it was trying to push it out (nurse verify because she felt it on her end, she said I guess your body didnt want that and we laughed (get my flu shots yearly and never an issue). Not so much this time

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-14
Report sent to call center — 6 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-23
Call 1 — Left Voicemail
2021-07-26
Call successful
Completed over the phone
2022-01-13
Survey response — 12 months, dose 1
MedDRA: Impaired work ability, Office visit, Rash, Weight decreased — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I am no longer able to work. I went to (b)(6) clinic and saw restorative neurology, gastro, allergyband internal medicine. I developed a severe rash and had a skin biopsy done as well as upper and lower scopes with biopsies. I have lost over 40 #

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-13	Moderna

Call center

7 call center cases

7 successful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-15

Systemic reaction (other): Increased heart rate. Increased thirst

2021-01-16

Systemic reaction (other): Elevated heart rate

2021-01-19

Systemic reaction (other): Still thirsty

Release 2 — day 14, dose 1

2021-01-27

Symptoms: Had to go on s beta blocker due to heart rate issues

Healthcare visit (other): HR was 166

Release 3 — day 21, dose 1

2021-02-03

Symptoms: Tired, headache. Anxious

Release 4 — day 28, dose 1

2021-02-10

Symptoms: Had ekg with irregularities

Healthcare visit (other): Outpatient tests on multiple days

Release 4 — day 35, dose 1

2021-02-17

Symptoms: Hospitalized since 2/14/21 due to increase HR and BP, which began after the first shot. I began medication metoprolol 25 mg to help on 1/21 and an increase on 2/5 to 50 mg. I just finished my 5th iv fluid bag.

Release 4 — day 42, dose 1

2021-02-24

Symptoms: Hospitalization with heart issues. Appointment with cardiologist in neighboring city tomorrow. I was instructed by my team of doctos to not get the second shot due to all these symptoms occurring aftwr the first.

Healthcare visit (other): Specialist appoimtments

Release 9 — 6 months, dose 1

2021-07-14

Symptoms: First react was vac going in L arm, it felt like it was trying to push it out (nurse verify because she felt it on her end, she said I guess your body didnt want that and we laughed (get my flu shots yearly and never an issue). Not so much this time cut off by CDC

Release 10 — 12 months, dose 1

2022-01-13

Symptoms: I am no longer able to work. I went to (b)(6) clinic and saw restorative neurology, gastro, allergyband internal medicine. I developed a severe rash and had a skin biopsy done as well as upper and lower scopes with biopsies. I have lost over 40 #

redacted (b)(6)

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	Heart rate increased	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Adverse reaction	✓	✓	✓
SD	Anxiety	✓	✓	✓
SD	Blood pressure increased	✓	✓	✓
SD	Electrocardiogram abnormal	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Heart rate increased	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Immunisation reaction	✓	✓	✓
SD	Impaired work ability	·	·	✓
SD	Office visit	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rash	·	·	✓
SD	Weight decreased	·	·	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Thirst	✓	✓	✓

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