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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1064123



Case Details

VAERS ID: 1064123 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-16
Onset:2021-02-28
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Exposure during pregnancy, Foetal death, Ultrasound antenatal screen 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? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lantus Valtrex Phenergan Cyclobenzaprine Prenatal Vitamin Unisom
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Ultrasound in hospital 2/28/2021 D&E scheduled 3/2/2021
CDC Split Type:

Write-up: Fetal demise sometime between 15-18 weeks based on ultrasound findings. EDC 7/30/2021


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