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This is VAERS ID 1053047

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1053047
VAERS Form:2
Age:69.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-02-19
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / -

Administered by: Public      Purchased by: ??
Symptoms: Petechiae, Laboratory test

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? No
Previous Vaccinations:
Other Medications: Xifacan, Olmesartan, Nadolol, Aspirin 81 mg, Levoxyl, Hydroxychloroquine, Omeprazole, D3 & B12 vitamins
Current Illness: Cirrhosis Diabetes under control without meds or insulin
Preexisting Conditions: Same
Allergies: None
Diagnostic Lab Data: Blood lab test ordered by my hematologist
CDC 'Split Type':

Write-up: Sudden outbreak of petechiae on both feet Sunday evening after Friday shot


Changed on 5/7/2021

VAERS ID: 1053047 Before After
VAERS Form:2
Age:69.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-02-19
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / -

Administered by: Public      Purchased by: ??
Symptoms: Petechiae, Laboratory test

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? No
Previous Vaccinations:
Other Medications: Xifacan, Olmesartan, Nadolol, Aspirin 81 mg, Levoxyl, Hydroxychloroquine, Omeprazole, D3 & B12 vitamins
Current Illness: Cirrhosis Diabetes under control without meds or insulin
Preexisting Conditions: Same
Allergies: None None
Diagnostic Lab Data: Blood lab test ordered by my hematologist
CDC 'Split Type':

Write-up: Sudden outbreak of petechiae on both feet Sunday evening after Friday shot


Changed on 5/21/2021

VAERS ID: 1053047 Before After
VAERS Form:2
Age:69.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-02-19
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / -

Administered by: Public      Purchased by: ??
Symptoms: Petechiae, Laboratory test

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? No
Previous Vaccinations:
Other Medications: Xifacan, Olmesartan, Nadolol, Aspirin 81 mg, Levoxyl, Hydroxychloroquine, Omeprazole, D3 & B12 vitamins
Current Illness: Cirrhosis Diabetes under control without meds or insulin
Preexisting Conditions: Same
Allergies: None None
Diagnostic Lab Data: Blood lab test ordered by my hematologist
CDC 'Split Type':

Write-up: Sudden outbreak of petechiae on both feet Sunday evening after Friday shot

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