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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1017013



Case Details

VAERS ID: 1017013 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-19
Onset:2021-01-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Pain, Pyrexia, Ultrasound scan
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Termination of pregnancy and risk of abortion (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, fluoxetine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Sonogram showing 6 weeks 4 days embryonic demise, corresponding to approx. 01/20/2021 as the date of demise.
CDC Split Type:

Write-up: Gravida 1 with last menstrual period of 12/05/2020. Patient received 2nd dose of vaccine on 01/19/2021. Patient had fever and body aches the next day 1/20/2021 and subsequently (3 weeks later) was diagnosed with a miscarriage of pregnancy at 6 weeks 4 days, which exactly corresponds with the date of the vaccine and symptoms.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1017013


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