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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1033516

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Case Details

VAERS ID: 1033516 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-29
Onset:2021-02-15
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Headache, Pain in extremity, Sleep disorder, Ultrasound abdomen abnormal, Ultrasound scan vagina abnormal
SMQs:, Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal multivitamin, iron supplement
Current Illness: On 1/20/2021 tested for Covid-19 via nasal swab due to having sore throat, fatigue, and headache. Test results came back negative that same day.
Preexisting Conditions: No chronic health issues, otherwise very healthy.
Allergies: NKA
Diagnostic Lab Data: On 2/16/21 I had an abdominal and vaginal ultrasounds, which confirmed absence of fetus in the uterus. Eptopic pregnancy was ruled out. MD was consulted on the same day regarding miscarriage.
CDC Split Type:

Write-up: At the time of administration of the first does of Moderna vaccine, I was 6 weeks pregnant. I had confirmed pregnancy with home positive test and missed period. I had an estimated due date of 9/24/2021. This was my 4th pregnancy. I have had two uncomplicated pregnancies to term. In September 2020 experienced a chemical pregnancy with early pregnancy loss at 5 weeks. The first 24 hours after 1st dose of vaccine I experienced extreme arm soreness in the arm that was vaccinated, causing headache and unable to sleep. After 24 hours I felt "normal". 2 weeks and 3 days following the first dose of Moderna, I had a miscarriage. On the night of 2/15/21 I lost the pregnancy with vaginal bleeding, bright red blood, passing tissue, clots/ sac. I had an uneventful pregnancy up to that point, feeling well as I had with prior pregnancies.


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