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Sitting on the toilet while defecating and vomiting into a nearby sink simultaneously after a hillbillies or mc donalds mcBreakfast a.k.a mc pukefest
Aww man, he did a backwards patrick and made a mess of the bog again, why the fuck does he eat that shit when he knows he'll end up wrecking the jax
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When one has diarrhea and vomits at the same time.
After he became incredibly drunk and proceeded to go to Taco Bell, Thomas pulled a Backwards Double Patrick.