ZXK-94875-50652

3 vaccinations 9 coded responses 18 check-ins 9 free-text entries 7 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 786 / TX
Registered: 2021-01-20

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

2021-01-20
Registered in v-safe
2021-01-20
Dose 1 — Pfizer-BioNTech
2021-01-20
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Survey response — day 7, dose 1
MedDRA: Extrasystoles, Unevaluable event — Feeling: Good · Site: Pain · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Heart skipping beats · Healthcare visit (other): One scheduled tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — day 7, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-04
Survey response — day 14, dose 1
MedDRA: Extrasystoles — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Heart skipping beats.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-10
Dose 2 — Pfizer-BioNTech
2021-02-10
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-03
Survey response — day 21, dose 2
MedDRA: Rash — Feeling: Good

Free text: Seems some rashes on skin. Will see dermatologist tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — day 35, dose 2
MedDRA: Heart rate irregular — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Erratic heart beat. Get pacemaker tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-15
Call 1 — Could Not Reach Participant
2021-04-20
Call 2 — Could Not Reach Participant
2021-04-24
Call 3 — Could Not Reach Participant
2021-05-12
Survey response — 3 months, dose 2
MedDRA: Arrhythmia, Hospitalisation, Postoperative wound infection — Feeling: Poor · Be unable to work, 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: After COVID shots developed heart arrhythmia necessitating pacemaker. The incision became infected, and I am now in hospital.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Report sent to call center — 3 months, 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)
2021-08-13
Survey response — 6 months, dose 2
MedDRA: Arrhythmia, Bradycardia, Cardiac operation — 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, Hospitalization

Free text: Symptoms: Heart arrhythmia and bradycardia · Healthcare visit (other): Retired pacemaker surgery

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-13
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)
2021-08-19
Call 1 — Left Voicemail
2021-08-23
Call successful
Not applicable - Accidental Reporting
2021-08-23
Call successful
Not applicable - Accidental Reporting
2021-08-23
Call successful
Not applicable - Accidental Reporting
2021-08-23
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-08-23
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-08
Dose 3 — Pfizer-BioNTech
2021-09-30
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-10-06
Survey response — day 28, dose 3
MedDRA: Vision blurred — Feeling: Good

Free text: Was driving today and suddenly I could not focus my eyes. Sensation lasted about 2 minutes

MedDRA releases: 2024-11 · check-in free text available
2021-10-13
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-10-20
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-09
Survey response — 6 months, dose 3
MedDRA: Pneumothorax, Rib fracture — Feeling: Poor · 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: 9 broken ribs and punctured lung

MedDRA releases: 2024-11 · check-in free text available
2022-03-09
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-03-17
Call 1 — Left Voicemail
2022-09-08
Survey response — 12 months, dose 3
MedDRA: Fall, Pneumothorax, Rib fracture — Feeling: Fair · Be unable to work or attend school, 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: 3 falls 9 broken ribs. Collapsed right lung.

MedDRA releases: 2024-11 · check-in free text available
2022-09-08
Report sent to call center — 12 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-09-09
Call 1 — Left Voicemail
2022-09-09
Call 1 — Left Voicemail
2022-09-09
Call X — Left Voicemail
2022-09-09
Call 2 — Left Voicemail
2022-09-09
Call 1 — Left Voicemail
2022-09-09
Call successful
Participant prefers to complete VAERS report online
2022-09-09
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-20	Pfizer-BioNTech
2	2021-02-10	Pfizer-BioNTech
3	2021-09-08	Pfizer-BioNTech	No

Call center

7 call center cases

7 successful

2 waits over 3 months for a first call

See the call center timeline

Free text

Release 2 — day 7, dose 1

2021-01-27

Systemic reaction (other): Heart skipping beats

Healthcare visit (other): One scheduled tomorrow

Release 3 — day 14, dose 1

2021-02-04

Symptoms: Heart skipping beats.

Release 5 — day 21, dose 2

2021-03-03

Symptoms: Seems some rashes on skin. Will see dermatologist tomorrow

Release 5 — day 35, dose 2

2021-03-17

Symptoms: Erratic heart beat. Get pacemaker tomorrow

Release 8 — 3 months, dose 2

2021-05-12

Symptoms: After COVID shots developed heart arrhythmia necessitating pacemaker. The incision became infected, and I am now in hospital.

Release 9 — 6 months, dose 2

2021-08-13

Symptoms: Heart arrhythmia and bradycardia

Healthcare visit (other): Retired pacemaker surgery

Release 10 — day 28, dose 3

2021-10-06

Symptoms: Was driving today and suddenly I could not focus my eyes. Sensation lasted about 2 minutes

Release 11 — 6 months, dose 3

2022-03-09

Symptoms: 9 broken ribs and punctured lung

Release 12 — 12 months, dose 3

2022-09-08

Symptoms: 3 falls 9 broken ribs. Collapsed right lung.

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 operation	✓	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Arrhythmia	✓	✓	✓
SD	Bradycardia	✓	·	✓
SD	Extrasystoles	✓	✓	✓
SD	Fall	·	·	✓
SD	Heart rate irregular	✓	✓	✓
SD	Hospitalisation	✓	✓	✓
SD	Pneumothorax	·	·	✓
SD	Postoperative wound infection	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rib fracture	·	·	✓
SD	Vision blurred	·	·	✓
SRO	Extrasystoles	✓	✓	✓

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