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6RZ-10129-08058

3 vaccinations 6 coded responses 15 check-ins 6 free-text entries 0 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
441 / OH
Registered
2021-03-12
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-17
    Dose 1 — Moderna
  2. 2021-03-12
    Registered in v-safe
  3. 2021-03-12
    Survey response — day 21, dose 1
    MedDRA: Extrasystoles — Feeling: Fair
    Free text: Skipped heartbeats
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-03-17
    Dose 2 — Moderna
  5. 2021-03-17
    Survey response — day 0, dose 2
    MedDRA: Unevaluable event — Feeling: Good
    Free text: I just got the shot an hour ago.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-03-18
    Survey response — days 1–6 daily, dose 2
    MedDRA: Feeling cold — Feeling: Good · Chills
    Free text: Its not really chills, I am just cold.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-03-19
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  8. 2021-03-20
    Survey response — days 1–6 daily, dose 2
    MedDRA: Extrasystoles — Feeling: Good
    Free text: Not sure if this is vaccine related, since I have had these skipped heartbeats before and not very often, but they started up again about a week and a half after the first shot. Sometimes its a few a day but sometimes its off and in for hours and then its perfect for a few days then starts again. Calling my cardiologist on Monday.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-03-21
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  10. 2021-03-22
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  11. 2021-03-23
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  12. 2021-03-26
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  13. 2021-03-31
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  14. 2021-06-16
    Survey response — 3 months, dose 2
    MedDRA: Extrasystoles, Office visit, Vaccine positive rechallenge — Feeling: Good
    Free text: Skipped ad extra heartbeats that started after the first vaccine. I only reported it once cause I wasnt sure. It got worse and then let up about 2 weeks later then after the second shot it was much worse. Cardiologist confirmed that it was vaccin
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-09-15
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  16. 2021-10-23
    Dose 3 — Moderna
    Co-administered: Flu
  17. 2021-10-28
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  18. 2021-10-30
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  19. 2022-10-24
    Survey response — 12 months, dose 3
    MedDRA: COVID-19 — Feeling: Fair
    Free text: Civid
    MedDRA releases: 2024-11 · check-in free text available

Vaccinations

DoseDateManufacturerCo-administered
12021-02-17Moderna
22021-03-17Moderna
32021-10-23Moderna Flu

Free text

Release 5 — day 21, dose 1

2021-03-12

Symptoms: Skipped heartbeats

Release 5 — day 0, dose 2

2021-03-17

Systemic reaction (other): I just got the shot an hour ago.

Release 5 — days 1–6 daily, dose 2

2021-03-18

Systemic reaction (other): Its not really chills, I am just cold.

Release 6 — days 1–6 daily, dose 2

2021-03-20

Systemic reaction (other): Not sure if this is vaccine related, since I have had these skipped heartbeats before and not very often, but they started up again about a week and a half after the first shot. Sometimes its a few a day but sometimes its off and in for hours and then its perfect for a few days then starts again. Calling my cardiologist on Monday.

Release 9 — 3 months, dose 2

2021-06-16

Symptoms: Skipped ad extra heartbeats that started after the first vaccine. I only reported it once cause I wasnt sure. It got worse and then let up about 2 weeks later then after the second shot it was much worse. Cardiologist confirmed that it was vaccin

Release 12 — 12 months, dose 3

2022-10-24

Symptoms: Civid

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
SDCOVID-19 · · ✓
SDExtrasystoles ✓ ✓ ✓
SDOffice visit · · ✓
SDVaccine positive rechallenge · · ✓
SROExtrasystoles ✓ ✓ ✓
SROFeeling cold ✓ ✓ ✓
SROUnevaluable event ✓ ✓ ✓

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

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