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This is VAERS ID 1490255

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1490255
VAERS Form:2
Age:47.0
Sex:Male
Location:Texas
Vaccinated:2021-04-21
Onset:2021-07-21
Submitted:0000-00-00
Entered:2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 - / -

Administered by: Private      Purchased by: ??
Symptoms: Seizure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-07-21
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:
Current Illness:
Preexisting Conditions: Hypothyroidism, diabetes mellitus, depressive disorder, schizophrenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Family reported patient had increased seizures after receiving vaccines. No documented hx of seizures prior to vaccines.

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