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This is VAERS ID 1368779

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368779
VAERS Form:2
Age:29.0
Sex:Male
Location:California
Vaccinated:2021-05-17
Onset:2021-05-17
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private      Purchased by: ??
Symptoms: Abdominal distension, Abdominal pain upper, Death, Insomnia, Myalgia, Nausea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-01
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: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: Los Angeles County Coroner''s case 2021-06655
CDC 'Split Type':

Write-up: After receiving second dose of vaccine, complained of stomach pain and feeling "bloated." Later had muscle pain, insomnia, and nausea. Found dead at home on 6/1.

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