YK8-23665-67687
4 vaccinations
4 coded responses
30 check-ins
3 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 955 / CA
- Registered
- 2021-10-27
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-02
Dose 1 — Moderna
-
2021-03-31
Dose 2 — Moderna
-
2021-10-27
Registered in v-safe
-
2021-10-27
Dose 3 — Moderna
- 2021-10-27
-
2021-10-28
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness, NauseaAdult check-in
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-10
-
2021-11-18
Survey response — day 21, dose 3MedDRA: Atrial flutter, Pre-existing disease, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Symptoms: I have a heart condition call SVT. I had a episode of atrial flutter that required an electrical shock. This was yesterday, today I feel good. Don't believe it is related to the vaccine. This has been a years long issue. · Healthcare visit (other): See above.MedDRA releases: 2024-11 · check-in free text available
-
2021-11-18
Report sent to call center — day 21, dose 3Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
-
2021-11-19
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-11-24
- 2021-12-01
- 2021-12-08
- 2022-01-26
-
2022-04-15
Dose 4 — Moderna
- 2022-04-15
-
2022-04-16
Health check-in — days 1–6 daily, dose 4Feeling: Poor · Site: Pain · Headache, Muscle or body achesAdult check-in
- 2022-04-17
- 2022-04-18
- 2022-04-19
- 2022-04-20
- 2022-04-21
-
2022-04-22
Survey response — day 7, dose 4MedDRA: Pre-existing disease — Feeling: GoodFree text: Some heart arrithnias. Have a history. Don't know if it's vaccine related.MedDRA releases: 2024-11 · check-in free text available
- 2022-04-30
- 2022-05-06
- 2022-05-13
- 2022-05-20
- 2022-05-27
-
2022-07-15
Survey response — 3 months, dose 4MedDRA: Pre-existing disease, Rash, Rash vesicular — Feeling: GoodFree text: Skin rash. Similar to Shingles. Have had Shingles in the past and have had both vaccines. Not as bad as full blown Shingles.MedDRA releases: 2024-11 · check-in free text available
- 2022-10-14
-
2023-04-17
Survey response — 12 months, dose 4MedDRA: Eye disorder, Visual impairment — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-04-17
Report sent to call center — 12 months, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2023-04-18
- 2023-04-26
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-02 | Moderna | No |
| 2 | 2021-03-31 | Moderna | No |
| 3 | 2021-10-27 | Moderna | No |
| 4 | 2022-04-15 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-11-18 | Successful 2021-11-19 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2023-04-17 | Unsuccessful |
Free text
Release 10 — day 21, dose 3
Symptoms: I have a heart condition call SVT. I had a episode of atrial flutter that required an electrical shock. This was yesterday, today I feel good. Don't believe it is related to the vaccine. This has been a years long issue.
Healthcare visit (other): See above.
Release 11 — day 7, dose 4
Systemic reaction (other): Some heart arrithnias. Have a history. Don't know if it's vaccine related.
Release 12 — 3 months, dose 4
Symptoms: Skin rash. Similar to Shingles. Have had Shingles in the past and have had both vaccines. Not as bad as full blown Shingles.
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 | Unevaluable event | · | · | ✓ |
| SD | Atrial flutter | · | · | ✓ |
| SD | Eye disorder | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Rash | · | · | ✓ |
| SD | Rash vesicular | · | · | ✓ |
| SD | Visual impairment | · | · | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release