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This is VAERS ID 1059615

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1059615
VAERS Form:2
Age:33.0
Sex:Female
Location:Tennessee
Vaccinated:2021-01-15
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Abortion spontaneous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Prenatal Vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Confirmed miscarriage at OB appt 2/24/2021
CDC 'Split Type':

Write-up: Miscarriage after receiving first Moderna vaccine dose


Changed on 5/7/2021

VAERS ID: 1059615 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Tennessee
Vaccinated:2021-01-15
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Abortion spontaneous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Prenatal Vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: NKA NKA
Diagnostic Lab Data: Confirmed miscarriage at OB appt 2/24/2021
CDC 'Split Type':

Write-up: Miscarriage after receiving first Moderna vaccine dose


Changed on 5/14/2021

VAERS ID: 1059615 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Tennessee
Vaccinated:2021-01-15
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Abortion spontaneous

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Prenatal Vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: NKA NKA
Diagnostic Lab Data: Confirmed miscarriage at OB appt 2/24/2021
CDC 'Split Type':

Write-up: Miscarriage after receiving first Moderna vaccine dose

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