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This is VAERS ID 1775868

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1775868
VAERS Form:2
Age:32.0
Sex:Female
Location:New York
Vaccinated:2021-09-30
Onset:2021-10-10
Submitted:0000-00-00
Entered:2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain upper, Headache, Myalgia, Urticaria

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? No
Previous Vaccinations:
Other Medications: Not available
Current Illness: Not available
Preexisting Conditions: Not available
Allergies: Not available
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Welts around injection site, headache, muscle pain, stomach ache.

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