64V-19396-40122
2 vaccinations
4 coded responses
23 check-ins
4 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 836 / ID
- Registered
- 2021-03-31
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-31
Registered in v-safe
-
2021-03-31
Dose 1 — Pfizer-BioNTech
- 2021-03-31
- 2021-04-02
- 2021-04-03
- 2021-04-04
- 2021-04-05
- 2021-04-06
- 2021-04-07
- 2021-04-14
-
2021-04-21
Dose 2 — Pfizer-BioNTech
- 2021-04-21
- 2021-04-22
- 2021-04-23
- 2021-04-24
- 2021-04-25
-
2021-04-26
Survey response — days 1–6 daily, dose 2MedDRA: Dry mouth, Gingival pain — Feeling: GoodFree text: Dry mouth & sore gums started a couple weeks ago but dont know if it is vaccine related.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-27
Survey response — days 1–6 daily, dose 2MedDRA: Dry mouth, Gingival pain — Feeling: GoodFree text: Dry mouth, sore gums. Not sure this vaccine related.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-28
Survey response — day 7, dose 2MedDRA: Dry mouth, Gingival pain — Feeling: Good · FeverFree text: Dry mouth, sore gumsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-05
- 2021-05-12
- 2021-05-19
- 2021-05-26
- 2021-06-02
- 2021-10-20
-
2022-04-21
Survey response — 12 months, dose 2MedDRA: Immunisation reaction, Lichen planus, Office visit, Respiratory tract congestion, Skin ulcer, Stomatitis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: It is my belief that the corona vaccines I received in April, 2021 caused a reaction. Around that same time, I developed sores in my mouth and on my skin that was later diagnosed as Lichen Planus. I also felt slightly congested. Dr's aren't sure.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-21
Report sent to call center — 12 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-04-22
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-31 | Pfizer-BioNTech | |
| 2 | 2021-04-21 | Pfizer-BioNTech |
Call center
1 call center case
1 unsuccessful
Free text
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): Dry mouth & sore gums started a couple weeks ago but dont know if it is vaccine related.
Systemic reaction (other): Dry mouth, sore gums. Not sure this vaccine related.
Release 8 — day 7, dose 2
Systemic reaction (other): Dry mouth, sore gums
Release 11 — 12 months, dose 2
Symptoms: It is my belief that the corona vaccines I received in April, 2021 caused a reaction. Around that same time, I developed sores in my mouth and on my skin that was later diagnosed as Lichen Planus. I also felt slightly congested. Dr's aren't sure.
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 | Immunisation reaction | · | · | ✓ |
| SD | Lichen planus | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Skin ulcer | · | · | ✓ |
| SD | Stomatitis | · | · | ✓ |
| SRO | Dry mouth | ✓ | ✓ | ✓ |
| SRO | Gingival pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release