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This is VAERS ID 992677

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 992677
VAERS Form:2
Age:64.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-25
Onset:2021-01-26
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041620A / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Back pain, Body temperature increased, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: Clonazepam, Mirtazapine, Seroquel, Austedo, Risperdal, Senna, Omeprazole
Current Illness:
Preexisting Conditions: Huntington''s Anxiety, Depression, Constipation.
Allergies: Paroxetine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Low Grade Temp, Persistent low back pain, Projectile Vomiting.


Changed on 5/7/2021

VAERS ID: 992677 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-25
Onset:2021-01-26
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041620A / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Back pain, Body temperature increased, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: Clonazepam, Mirtazapine, Seroquel, Austedo, Risperdal, Senna, Omeprazole
Current Illness:
Preexisting Conditions: Huntington''s Anxiety, Depression, Constipation.
Allergies: Paroxetine Paroxetine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Low Grade Temp, Persistent low back pain, Projectile Vomiting.


Changed on 5/14/2021

VAERS ID: 992677 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-25
Onset:2021-01-26
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041620A / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Back pain, Body temperature increased, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: Clonazepam, Mirtazapine, Seroquel, Austedo, Risperdal, Senna, Omeprazole
Current Illness:
Preexisting Conditions: Huntington''s Anxiety, Depression, Constipation.
Allergies: Paroxetine Paroxetine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Low Grade Temp, Persistent low back pain, Projectile Vomiting.

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