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This is VAERS ID 1779506

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1779506
VAERS Form:2
Age:28.0
Sex:Female
Location:New York
Vaccinated:2021-10-09
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Private      Purchased by: ??
Symptoms: Headache, Hypertension, Nausea, Pain, Urticaria, SARS-CoV-2 test negative

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Gluten wheat shellfish latex
Diagnostic Lab Data: Went to doctor. Complete covid test . Negative result. Did an over all check ask vitals. High BP as well
CDC 'Split Type':

Write-up: Extreme headache nausea hives on face and neck eye flare up pain all over body

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