XVV-10953-93759
1 vaccination
6 coded responses
7 check-ins
6 free-text entries
5 call cases
- Sex
- Male
- Age at first dose
- 56-60
- ZIP prefix
- 905 / CA
- Registered
- 2021-04-03
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-25
Dose 1 — Moderna
-
2021-04-03
Registered in v-safe
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2021-04-03
Survey response — 7 day, dose 1MedDRA: Chills, Dyspnoea, Emergency care, Hypertension, Myocardial infarction — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · 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 visitMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-04-03
Report sent to call center — 7 day, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-08
Survey response — 14 day, dose 1MedDRA: Asthenia, Malaise, Nausea — 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 visitMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
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2021-04-08
Report sent to call center — 14 day, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-19
Survey response — 21 day, dose 1MedDRA: Arthralgia, Cardiac disorder, Chills, Headache, Heart rate increased, Hypertension, Nausea, Pyrexia — 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 visitMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
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2021-04-19
Report sent to call center — 21 day, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-22
Survey response — 28 day, dose 1MedDRA: Dyspnoea, Headache, Myocardial infarction — 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 visitMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
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2021-04-22
Report sent to call center — 28 day, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-29
Survey response — 35 day, dose 1MedDRA: Dyspnoea, Myocardial infarction — 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 visitMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
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2021-04-29
Report sent to call center — 35 day, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-06-15
- 2021-06-24
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2021-09-23
Survey response — 6 month, dose 1MedDRA: Myocardial infarction, Thrombosis, Transient ischaemic attack — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activitiesMedDRA releases: 2024-11 · check-in answers available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-25 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-04-03 | Unsuccessful | |
| 2021-04-08 | Unsuccessful | |
| 2021-04-19 | Unsuccessful | |
| 2021-04-22 | Unsuccessful | |
| 2021-04-29 | Unsuccessful |
Free text
Release 6
Systemic reaction (other): Severe high blood pressure, heart rate which caused hundreds of short heart attacks, difficulty breathing, shivering uncontrollably
Healthcare visit (other): The ER wanted to admit me to do some tests, but I chose to do the tests on an outpatient basis.
Release 7
Symptoms: I feel sick, weak, nauseous, and I am in really very very very poor condition. This vaccine may kill me yet. I've been sick and all of the above and more ever since I made the mistake of listening to my PCP and took the Maderna Covid19 vaccine.
Symptoms: Severe headache, shivering uncontrollably, joints hurt especially shoulders, elbows, fingers, wrists, hips, knees, ankles and toes. Nausea, fever comes and goes, high blood pressure and heart rate, and short heart attacks hundreds of times daily.
Symptoms: Im having HEART ATTACKS and GREAT DIFFICULTY BREATHING and HEADACHES alongside all the other symptoms previously listed.
Release 8
Symptoms: Im having heart attacks everyday and great difficulty breathing among many other symptoms.
Release 9
Symptoms: Blood clots that caused several heart attacks and a mini stroke.
Free-text releases are not linked to a specific 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 | Emergency care | ✓ | ✓ | ✓ |
| SD | Arthralgia | ✓ | ✓ | ✓ |
| SD | Asthenia | ✓ | ✓ | ✓ |
| SD | Cardiac disorder | ✓ | ✓ | ✓ |
| SD | Chills | ✓ | ✓ | ✓ |
| SD | Dyspnoea | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Heart rate increased | ✓ | ✓ | ✓ |
| SD | Hypertension | ✓ | ✓ | ✓ |
| SD | Malaise | ✓ | ✓ | ✓ |
| SD | Myocardial infarction | ✓ | ✓ | ✓ |
| SD | Nausea | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Thrombosis | · | · | ✓ |
| SD | Transient ischaemic attack | · | · | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Dyspnoea | ✓ | ✓ | ✓ |
| SRO | Hypertension | ✓ | ✓ | ✓ |
| SRO | Myocardial infarction | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release