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This is VAERS ID 1759157

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1759157
VAERS Form:2
Age:98.0
Sex:Male
Location:Connecticut
Vaccinated:2020-12-22
Onset:2020-12-23
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL0140 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Communication disorder, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-11
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: Tylenol 650mg @ 9 AM/1 PM/5 PM
Current Illness: None
Preexisting Conditions: Dementia
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cessation of talking and eating followed by death.

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