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This is VAERS ID 1696135

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1696135
VAERS Form:2
Age:58.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-09-13
Onset:2021-09-13
Submitted:0000-00-00
Entered:2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Hyperhidrosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: penicillins- rash
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Sweating/dizziness

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