| Days after vaccination:||7
|Vaccination / Manufacturer
||Lot / Dose
||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA
||028L20A / 2
||RA / IM
Administered by: Private Purchased by: ?
Symptoms: Abortion spontaneous,
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Other Medications: Pre-natal vitamin
Current Illness: No illness known. Involved in motor vehicle accident on 2/1/21, prior to being vaccinated- reports she sustained back pain and whiplash.
Preexisting Conditions: None known
Diagnostic Lab Data: HCG
CDC Split Type:
Write-up: Reports she was vaccinated on 2/1/21, found out she was pregnant on on 2/3/21, and miscarried the pregnancy on 2/8/21. Additionally, she was involved in a motor vehicle accident on 2/1/21, prior to her vaccine, sustaining back pain and whiplash. Lastly, reports she began having visual changes on 2/3/21 and was diagnosed with a detached retina on 2/10/21.