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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1785570

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Case Details

VAERS ID: 1785570 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diplopia, Fatigue
SMQs:, Ocular motility disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions:
Allergies: Penicillin, Gabapentin, Percocet.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Double vision, fatigue.


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