YPJ-22887-29062

2 vaccinations 6 coded responses 23 check-ins 6 free-text entries 4 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 453 / OH
Registered: 2020-12-25

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

2020-12-23
Dose 1 — Moderna
2020-12-25
Registered in v-safe
2020-12-25
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · 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
2020-12-25
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)
2020-12-26
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite — Feeling: Good · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Free text: Loss of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Chills, Headache

Adult check-in
2020-12-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-30
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-07
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-15
Survey response — day 21, dose 1
MedDRA: Myocarditis, Ventricular tachycardia — 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: Ventricular tachycardia. Resistant to shocking. Needing an ICD possibly. Myocarditis.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Report sent to call center — day 21, 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)
2021-01-20
Survey response — day 28, dose 1
MedDRA: Cardio-respiratory arrest, Decreased appetite, Dyspnoea, Endotracheal intubation, Heart rate irregular, Implantable defibrillator insertion, Sudden cardiac death — 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: Shortness of breath. Heart irregularities. Loss of appetite. Insertion of Implanted cardio defibrillator as result of sudden cardiac death. Coded three times in two days. Intubation. Extubated and reintubated with successful extubation over 2 day

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-20
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)
2021-01-27
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-02-03
Dose 2 — Moderna
2021-02-03
Survey response — day 0, dose 2
MedDRA: Cardio-respiratory arrest, Chest pain, Condition aggravated, Dyspnoea, Emergency care, Fatigue, Hypertension, Mechanical ventilation, Pre-existing disease, Syncope, Ventricular tachycardia, Vertigo — Feeling: Fair · Muscle or body aches · 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: I have developed viral myocarditis with sudden cardiac death and an ICD implant. The myocarditis is suspected as result of COVID in March 2020. Following my first vaccine I developed many of the same symptoms I had with COVID. I had discussed with my physician. Suspected I was a long hauler. After the initial vaccine the fatigue and shortness of breath worsened. I was unable to walk a flight of stairs. On January 12 I had to call 911 for syncope and chest pain. I coded 3 times was on the vent twice. I feel that recognizing long term cardiac conditions are poorly studied and followed. I continued with uncontrolled hypertension. I had a long term history of vertigo which had become almost intolerable since COVID and after the initial vaccine. It is suspected my vertigo was related to self limiting ventricular tachycardia. The result of viral myocarditis.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Report sent to call center — day 0, dose 2
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)
2021-02-04
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea — Feeling: Fair · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Shortness of breath.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: COVID-19, Dyspnoea, Dyspnoea exertional, Impaired work ability, Myocarditis, Sudden cardiac death, Viral myocarditis — Feeling: Fair · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Shortness if breath with mild activity. Off work currently after ICD placement for sudden cardiac death related to viral myocarditis from COVID.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-10
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-18
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-02-25
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-05
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-10
Call 1 — Left Voicemail
2021-03-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-06
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-05-06
Call 1 — Left Voicemail
2021-08-07
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-02-04
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-23	Moderna
2	2021-02-03	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2020-12-25	Unsuccessful
2021-01-15	Unsuccessful
2021-01-20	Unsuccessful
2021-02-03	Unsuccessful

Free text

Release 1 — days 1–6 daily, dose 1

2020-12-26

Systemic reaction (other): Loss of appetite

Release 2 — day 21, dose 1

2021-01-15

Symptoms: Ventricular tachycardia. Resistant to shocking. Needing an ICD possibly. Myocarditis.

Release 2 — day 28, dose 1

2021-01-20

Symptoms: Shortness of breath. Heart irregularities. Loss of appetite. Insertion of Implanted cardio defibrillator as result of sudden cardiac death. Coded three times in two days. Intubation. Extubated and reintubated with successful extubation over 2 day cut off by CDC

Release 3 — day 0, dose 2

2021-02-03

Systemic reaction (other): I have developed viral myocarditis with sudden cardiac death and an ICD implant. The myocarditis is suspected as result of COVID in March 2020. Following my first vaccine I developed many of the same symptoms I had with COVID. I had discussed with my physician. Suspected I was a long hauler. After the initial vaccine the fatigue and shortness of breath worsened. I was unable to walk a flight of stairs. On January 12 I had to call 911 for syncope and chest pain. I coded 3 times was on the vent twice. I feel that recognizing long term cardiac conditions are poorly studied and followed. I continued with uncontrolled hypertension. I had a long term history of vertigo which had become almost intolerable since COVID and after the initial vaccine. It is suspected my vertigo was related to self limiting ventricular tachycardia. The result of viral myocarditis.

Release 3 — days 1–6 daily, dose 2

2021-02-07

Systemic reaction (other): Shortness of breath.

2021-02-08

Systemic reaction (other): Shortness if breath with mild activity. Off work currently after ICD placement for sudden cardiac death related to viral myocarditis from COVID.

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
SD	Cardio-respiratory arrest	✓	✓	✓
SD	Decreased appetite	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Endotracheal intubation	✓	✓	✓
SD	Heart rate irregular	✓	✓	✓
SD	Implantable defibrillator insertion	✓	✓	✓
SD	Myocarditis	✓	✓	✓
SD	Sudden cardiac death	✓	✓	✓
SD	Ventricular tachycardia	✓	✓	✓
SRO	Cardio-respiratory arrest	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	COVID-19	·	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Dyspnoea exertional	·	·	✓
SRO	Emergency care	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Hypertension	✓	✓	✓
SRO	Impaired work ability	·	·	✓
SRO	Mechanical ventilation	✓	✓	✓
SRO	Myocarditis	✓	✓	○
SRO	Pre-existing disease	✓	✓	✓
SRO	Sudden cardiac death	·	·	✓
SRO	Syncope	✓	✓	✓
SRO	Ventricular tachycardia	✓	✓	✓
SRO	Vertigo	✓	✓	✓
SRO	Viral myocarditis	·	·	✓

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