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This is VAERS ID 1759421

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1759421
VAERS Form:2
Age:61.0
Sex:Male
Location:New York
Vaccinated:2021-09-24
Onset:2021-09-30
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 AR / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. - / 1 AR / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pruritus, Sleep disorder, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Medformin 1000MG, Simvastatin 20MG, Baby Aspirin 59mg, Glipiside 5 MG
Current Illness: Diabetes
Preexisting Conditions: Diabetes, Asthma
Allergies: NONE until 9/30
Diagnostic Lab Data: physician exam
CDC 'Split Type':

Write-up: Approx 1 week after receiving both vaccines, hives started on ankles and proceeded up body. Last two nights could not sleep account hives itching. Ruled out bugs account spouse sleeping in same bed with no hives.

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