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This is VAERS ID 1064123

History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1064123
VAERS Form:2
Age:40.0
Sex:Female
Location:Kentucky
Vaccinated:2021-02-16
Onset:2021-02-28
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: Ultrasound antenatal screen abnormal, Foetal death, Exposure during pregnancy

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     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


Changed on 5/7/2021

VAERS ID: 1064123 Before After
VAERS Form:2
Age:40.0
Sex:Female
Location:Kentucky
Vaccinated:2021-02-16
Onset:2021-02-28
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: Ultrasound antenatal screen abnormal, Foetal death, Exposure during pregnancy

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     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 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


Changed on 5/14/2021

VAERS ID: 1064123 Before After
VAERS Form:2
Age:40.0
Sex:Female
Location:Kentucky
Vaccinated:2021-02-16
Onset:2021-02-28
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: Ultrasound antenatal screen abnormal, Foetal death, Exposure during pregnancy

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     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 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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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1064123&WAYBACKHISTORY=ON

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