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This is VAERS ID 1038609

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1038609
VAERS Form:2
Age:73.0
Sex:Male
Location:New York
Vaccinated:2021-01-27
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Atrial fibrillation, Ischaemic stroke, Internal capsule infarction

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: st johns wort metformin 500mg bid
Current Illness: type 2 diabetes
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: hospitalized at hospital 9 days
CDC 'Split Type':

Write-up: Atrial fibrillation, ischemic stroke right internal capsule, ER, tpa, recovered much of neurologic deficit


Changed on 5/7/2021

VAERS ID: 1038609 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:New York
Vaccinated:2021-01-27
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Atrial fibrillation, Ischaemic stroke, Internal capsule infarction

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: st johns wort metformin 500mg bid
Current Illness: type 2 diabetes
Preexisting Conditions:
Allergies: none none
Diagnostic Lab Data: hospitalized at hospital 9 days
CDC 'Split Type':

Write-up: Atrial fibrillation, ischemic stroke right internal capsule, ER, tpa, recovered much of neurologic deficit


Changed on 5/21/2021

VAERS ID: 1038609 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:New York
Vaccinated:2021-01-27
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Atrial fibrillation, Ischaemic stroke, Internal capsule infarction

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: st johns wort metformin 500mg bid
Current Illness: type 2 diabetes
Preexisting Conditions:
Allergies: none none
Diagnostic Lab Data: hospitalized at hospital 9 days
CDC 'Split Type':

Write-up: Atrial fibrillation, ischemic stroke right internal capsule, ER, tpa, recovered much of neurologic deficit

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