29K-34702-30253 · OpenVSafe

Timeline

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

2021-01-21
Dose 1 — Moderna
2021-02-18
Dose 2 — Moderna
2021-03-07
Registered in v-safe
2021-03-07
Survey response — day 14, dose 2
MedDRA: Injection site pain, Lethargy — Feeling: Good

Free text: LethargyInjection site soreness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-04
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-20
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-19
Survey response — 6 months, dose 2
MedDRA: Hospitalisation, Mechanical ventilation, Myasthenia gravis, Neurotoxicity — Feeling: Poor · 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, Hospitalization

Free text: Symptoms: June 23 admitted for sudden onset myasthenia gravis thought to be related to receiving Opdivo immunotherapy - admitted to St Johns Providence Santa Monica CA and transferred and now at Barlow Respiratory Hospital Los Angeles, CA on ventilator · Healthcare visit (other): Neurotoxic reaction - on Ventilatorn

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-19
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-27
Call 1 — Left Voicemail
2022-02-20
Survey response — 12 months, dose 2
MedDRA: Death, Hospitalisation, Myasthenia gravis, Myocarditis, SARS-CoV-2 test negative, Unevaluable event — Feeling: Poor · Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: After Moderna received 2 half doses of Opdivo in June 2021 - developed severe myocarditis and Myasthenia Gravis. The end result after 230 days in acute hospital setting was death in Feb 2022. Tested Covid negative · Healthcare visit (other): June 23, 2020 to Feb 8, 2022

MedDRA releases: 2024-11 · check-in free text available
2022-02-20
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-02-22
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Moderna
2	2021-02-18	Moderna

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 5 — day 14, dose 2

2021-03-07

Symptoms: LethargyInjection site soreness

Release 9 — 6 months, dose 2

2021-08-19

Symptoms: June 23 admitted for sudden onset myasthenia gravis thought to be related to receiving Opdivo immunotherapy - admitted to St Johns Providence Santa Monica CA and transferred and now at Barlow Respiratory Hospital Los Angeles, CA on ventilator

Healthcare visit (other): Neurotoxic reaction - on Ventilatorn

Release 11 — 12 months, dose 2

Reports this person's death

2022-02-20

Symptoms: After Moderna received 2 half doses of Opdivo in June 2021 - developed severe myocarditis and Myasthenia Gravis. The end result after 230 days in acute hospital setting was death in Feb 2022. Tested Covid negative

Healthcare visit (other): June 23, 2020 to Feb 8, 2022

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	Neurotoxicity	✓	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Death	·	·	✓
SD	Hospitalisation	✓	·	✓
SD	Injection site pain	✓	✓	✓
SD	Lethargy	✓	✓	✓
SD	Mechanical ventilation	✓	·	✓
SD	Myasthenia gravis	✓	·	✓
SD	Myocarditis	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓

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