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This is VAERS ID 1028819

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1028819
VAERS Form:2
Age:39.0
Sex:Female
Location:Missouri
Vaccinated:2020-12-18
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abortion spontaneous, Ultrasound antenatal screen abnormal, Foetal heart rate abnormal, Human chorionic gonadotropin decreased, Exposure during pregnancy

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Zyrtec, Benadryl, flexeril, prenatal vitamins.
Current Illness: None
Preexisting Conditions: Anxiety, migraines
Allergies: Latex, PCN, sulfa, reglan, phenergan
Diagnostic Lab Data: 2/3 - ultrasound showed no heartbeat 2/5 - beta hcg quant - 41,xxx 2/7 - beta hcg quant - 40,xxx 2/11 - 2nd confirmation ultrasound. 2/11 - beta hcg quant - 35,xxx
CDC 'Split Type':

Write-up: First trimester miscarriage after receiving both vaccine doses while pregnant. Granada 5, Para 3 at time of vaccine administration. Due date 9/17/2021


Changed on 5/7/2021

VAERS ID: 1028819 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Missouri
Vaccinated:2020-12-18
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abortion spontaneous, Ultrasound antenatal screen abnormal, Foetal heart rate abnormal, Human chorionic gonadotropin decreased, Exposure during pregnancy

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Zyrtec, Benadryl, flexeril, prenatal vitamins.
Current Illness: None
Preexisting Conditions: Anxiety, migraines
Allergies: Latex, PCN, sulfa, reglan, phenergan phenergan
Diagnostic Lab Data: 2/3 - ultrasound showed no heartbeat 2/5 - beta hcg quant - 41,xxx 2/7 - beta hcg quant - 40,xxx 2/11 - 2nd confirmation ultrasound. 2/11 - beta hcg quant - 35,xxx
CDC 'Split Type':

Write-up: First trimester miscarriage after receiving both vaccine doses while pregnant. Granada 5, Para 3 at time of vaccine administration. Due date 9/17/2021


Changed on 5/14/2021

VAERS ID: 1028819 Before After
VAERS Form:2
Age:39.0
Sex:Female
Location:Missouri
Vaccinated:2020-12-18
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abortion spontaneous, Ultrasound antenatal screen abnormal, Foetal heart rate abnormal, Human chorionic gonadotropin decreased, Exposure during pregnancy

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, Zyrtec, Benadryl, flexeril, prenatal vitamins.
Current Illness: None
Preexisting Conditions: Anxiety, migraines
Allergies: Latex, PCN, sulfa, reglan, phenergan phenergan
Diagnostic Lab Data: 2/3 - ultrasound showed no heartbeat 2/5 - beta hcg quant - 41,xxx 2/7 - beta hcg quant - 40,xxx 2/11 - 2nd confirmation ultrasound. 2/11 - beta hcg quant - 35,xxx
CDC 'Split Type':

Write-up: First trimester miscarriage after receiving both vaccine doses while pregnant. Granada 5, Para 3 at time of vaccine administration. Due date 9/17/2021

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