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This is VAERS ID 1775863

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775863
VAERS Form:2
Age:53.0
Sex:Female
Location:New York
Vaccinated:2021-10-10
Onset:2021-10-10
Submitted:0000-00-00
Entered:2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 LA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cerebrovascular accident

Life Threatening? Yes
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: 28     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan 50mg HYDROCHLOROTHIAZIDE 25MG LOESTRIN FE 1.5/30 1.5-30
Current Illness: Hypertension
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Possibly causing stroke 5 months after receiving Moderna Covid-19 vaccine

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