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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1094454



Case Details

VAERS ID: 1094454 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-11
Onset:2021-02-27
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Abdominal pain, Abortion spontaneous, Back pain, Blood test, Exposure during pregnancy, Ultrasound antenatal screen abnormal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: prenatal vitamins with choline tablet (One-A-Day) Calcium supplement with Vitamin D
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: I had my blood drawn, an ultrasound, and a pelvic exam in the Emergency Room on 2/27/2021. Results were consistent with incomplete miscarriage at that time. No other abnormalities were noted.
CDC Split Type:

Write-up: I experienced a miscarriage on February 27th, 2021. I was approximately 10 weeks pregnant when I experienced the miscarriage. It was accompanied by severe pain/cramps in the abdomen and lower back. Expected delivery would have been in September 2021. This was my first pregnancy.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1094454


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