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This is VAERS ID 1261766

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1261766
VAERS Form:2
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2021-04-08
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Body temperature increased, Death, Seizure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased body temperature, seizure, death


Changed on 5/7/2021

VAERS ID: 1261766 Before After
VAERS Form:2
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2021-04-08
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Body temperature increased, Death, Seizure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased body temperature, seizure, death


Changed on 5/14/2021

VAERS ID: 1261766 Before After
VAERS Form:2
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2021-04-08
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Body temperature increased, Death, Seizure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased body temperature, seizure, death

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1261766&WAYBACKHISTORY=ON


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