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This is VAERS ID 1696406

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1696406
VAERS Form:2
Age:74.0
Sex:Male
Location:Michigan
Vaccinated:2021-04-24
Onset:2021-09-13
Submitted:0000-00-00
Entered:2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Acute respiratory failure, COVID-19

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hospitalization - acute hypoxemic respiratory failure due to COVID-19

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1696406&WAYBACKHISTORY=ON


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