5XK-21168-53779
4 vaccinations
3 coded responses
40 check-ins
3 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 936 / CA
- Registered
- 2021-01-20
- Relationship
- Self
- Race
- Asian
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-20
Registered in v-safe
-
2021-01-20
Dose 1 — Pfizer-BioNTech
- 2021-01-20
- 2021-01-21
- 2021-01-22
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-01-26
- 2021-01-27
- 2021-02-03
-
2021-02-10
Dose 2 — Pfizer-BioNTech
- 2021-02-10
- 2021-02-11
- 2021-02-12
- 2021-02-13
- 2021-02-14
- 2021-02-16
- 2021-02-17
- 2021-02-24
- 2021-03-11
- 2021-03-17
- 2021-03-24
- 2021-05-12
- 2021-08-13
-
2021-09-24
Dose 3 — Pfizer-BioNTechCo-administered: Flu
- 2021-09-29
- 2021-09-30
- 2021-10-01
- 2021-10-08
- 2021-10-15
- 2021-10-22
- 2021-10-29
- 2021-11-06
-
2022-03-27
Survey response — 6 months, dose 3MedDRA: Blood pressure increased, COVID-19, Dizziness, Emergency care, SARS-CoV-2 test positive — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Symptoms: Tested positive for Covid-19 on 1/28/22 and high blood pressure 240/132. Extensive medical tests showed no causes other than Covid-19. I experienced a bit dizziness but no other Covid related symptoms. · Healthcare visit (other): Transport by helicopter from (b)(6) to (b)(6) in (b)(6)MedDRA releases: 2024-11 · check-in free text available
-
2022-03-27
Report sent to call center — 6 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2022-03-29
Call successfulCompleted over the phone
-
2022-04-01
Dose 4 — Pfizer-BioNTech
-
2022-04-14
Survey response — day 7, dose 4MedDRA: Hypertension — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: High blood pressure range upto 170/93MedDRA releases: 2024-11 · check-in free text available
-
2022-04-14
Report sent to call center — day 7, dose 4Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-04-15
-
2022-04-19
Call successfulDoes not wish to fill out VAERS report
- 2022-04-22
- 2022-05-01
- 2022-05-06
- 2022-05-13
-
2022-07-01
Survey response — 3 months, dose 4MedDRA: Cardiac pacemaker insertion, Heart rate decreased, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Heart rate dips below 40 at night during sleep. Cardiologist implanted a pacemaker on 6/29/22 · Healthcare visit (other): Pace maker implant at an outpatient surgical centerMedDRA releases: 2024-11 · check-in free text available
-
2022-07-01
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-07-05
- 2022-07-05
- 2022-07-05
-
2022-07-06
Callback requested for03:00PM ET
-
2022-07-06
Call successfulDoes not wish to fill out VAERS report
- 2022-10-02
- 2023-04-03
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-20 | Pfizer-BioNTech | |
| 2 | 2021-02-10 | Pfizer-BioNTech | |
| 3 | 2021-09-24 | Pfizer-BioNTech | Flu |
| 4 | 2022-04-01 | Pfizer-BioNTech | No |
Call center
3 call center cases
3 successful
VAERS report filed, before or during a call: 1
1 wait over 3 months for a first call
Free text
Release 11 — 6 months, dose 3
Symptoms: Tested positive for Covid-19 on 1/28/22 and high blood pressure 240/132. Extensive medical tests showed no causes other than Covid-19. I experienced a bit dizziness but no other Covid related symptoms.
Healthcare visit (other): Transport by helicopter from (b)(6) to (b)(6) in (b)(6)
redacted (b)(6)
Release 11 — day 7, dose 4
Systemic reaction (other): High blood pressure range upto 170/93
Release 12 — 3 months, dose 4
Symptoms: Heart rate dips below 40 at night during sleep. Cardiologist implanted a pacemaker on 6/29/22
Healthcare visit (other): Pace maker implant at an outpatient surgical center
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 | Cardiac pacemaker insertion | · | · | ✓ |
| HCVO | Emergency care | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| SD | Blood pressure increased | · | · | ✓ |
| SD | Cardiac pacemaker insertion | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Dizziness | · | · | ✓ |
| SD | Heart rate decreased | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Hypertension | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release