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uninstalling/reinstalling games/mods uninstalls/reinstalls downloaded files ONLY. the process does NOT remove any folders/files created when the game runs. I recently uninstalled Fallout 4 - in the steam game folder I found a .dll library and a .ini file that I had been experimenting with and had forgotten about.
go to folder
....\steam\steamapps\common
rename fallout new vegas folder something else like falloutnvOLD
go to folder
c:\users\yourWindowsLogin\appdata\local
rename FalloutNV folder something else like FalloutNVOLD
go to folder
Documents\My Games
rename FalloutNV folder something else like FalloutNVOLD (your save files are in this folder)
now steam verify game files. steam will download and install just the game files into new empty folders. start a new game and see if just the vanilla game works. if so, move the save files from the old Saves folder to the working Saves folder
all your old files are still in the FalloutNVOLD folders so if something goes wrong, you can restore everything.
Simply clicking on the patcher.exe will apply the 4gb Patcher again. If the game fails to load it's another issue unrelated to the patcher.
Defender and other AV interfere with binary patchers, always, even if it developer's patchers, signed. - exclude \ disable folder and file \ process from online (on the fly) protection BEFORE patching ORIGINAL file