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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1063163



Case Details

VAERS ID: 1063163 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-01-19
Onset:2021-02-03
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Foetal death, Foetal heart rate abnormal, Ultrasound antenatal screen abnormal, Ultrasound foetal abnormal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PRENATAL, VITAMIN D, B COMPLEX
Current Illness:
Preexisting Conditions: ANXIETY, MIGRAINES, IBS
Allergies:
Diagnostic Lab Data: Ultrasound - Feb 3
CDC Split Type:

Write-up: Saw OB on Jan 4 and there was a strong heartbeat and no defects or problems noted in any bloodwork up to that point in the pregnancy. Received my second vaccine on Jan 19. On Feb 3 I went to my next ultrasound appointment and was told that the baby had no heartbeat. It was estimated that the baby had likely passed a couple weeks prior but I am not certain of the timeline in regards to receiving the second vaccine.


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