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This is VAERS ID 1542057

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History of Changes from the VAERS Wayback Machine

First Appeared on 8/13/2021

VAERS ID: 1542057
VAERS Form:2
Age:69.0
Sex:Female
Location:Connecticut
Vaccinated:2021-06-15
Onset:2021-07-06
Submitted:0000-00-00
Entered:2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 UN / UN

Administered by: Other      Purchased by: ??
Symptoms: Aphasia, Bacteraemia, Blood culture, Computerised tomogram, Culture urine, Death, Dyspnoea, Gait inability, Pain, Pemphigoid, Ultrasound scan, Peripheral swelling, Central venous catheterisation, Disease recurrence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-07
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium supplements, vitamin D3
Current Illness: Bullous Pemphilgoid
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Admitted to hospital 7/9/21 CT scans, urine/ blood cultures, ultrasounds, Moderna 006C21A 2nd dose given at hospital 7/13/21 Central line placement 7/12/21
CDC 'Split Type':

Write-up: Extremely painful recurrence of bulbous phemphigoid covered most of body. 3.5 weeks after initial vaccine. Required hospitalization 3 times and admission to rehab twice. Unable to walk, difficulty breathing, swollen legs, 2nd hospital. Unable to speak or walk 3rd hosp, ended in death/ bacteremia.

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