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This is VAERS ID 1685644

History of Changes from the VAERS Wayback Machine

First Appeared on 9/10/2021

VAERS ID: 1685644
VAERS Form:2
Age:78.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-02-13
Onset:2021-02-15
Submitted:0000-00-00
Entered:2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024MZOA / UNK - / SYR

Administered by: Private      Purchased by: ??
Symptoms: Death, Feeling abnormal, Gait inability, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-22
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: Seroquel
Current Illness: Lewy Bodie dementia Lyden factor five
Preexisting Conditions: Lyden factor five -Lewy bodies dementia
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: He received the vaccine on 2/13/21 by 2/15/21 he was not feeling himself didn?t really eat by 2/17/21 he couldn?t walk by 2/19/21 he was admitted to hospice and by 2/22/21 he passed away

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