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This is VAERS ID 1036544

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1036544
VAERS Form:2
Age:67.0
Sex:Male
Location:North Carolina
Vaccinated:2021-02-05
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / -

Administered by: Public      Purchased by: ??
Symptoms: Full blood count, Blood smear test, Immune thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Covid-19 on 01/01/2021
Preexisting Conditions: Hypertension
Allergies: No Known Allergies
Diagnostic Lab Data: CBC, peripheral smear 02/16/2021
CDC 'Split Type':

Write-up: Immune thrombocytopenia


Changed on 5/7/2021

VAERS ID: 1036544 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:North Carolina
Vaccinated:2021-02-05
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / -

Administered by: Public      Purchased by: ??
Symptoms: Full blood count, Blood smear test, Immune thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Covid-19 on 01/01/2021
Preexisting Conditions: Hypertension
Allergies: No Known Allergies Allergies
Diagnostic Lab Data: CBC, peripheral smear 02/16/2021
CDC 'Split Type':

Write-up: Immune thrombocytopenia


Changed on 5/21/2021

VAERS ID: 1036544 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:North Carolina
Vaccinated:2021-02-05
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 - / -

Administered by: Public      Purchased by: ??
Symptoms: Full blood count, Blood smear test, Immune thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Covid-19 on 01/01/2021
Preexisting Conditions: Hypertension
Allergies: No Known Allergies Allergies
Diagnostic Lab Data: CBC, peripheral smear 02/16/2021
CDC 'Split Type':

Write-up: Immune thrombocytopenia

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