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

This is VAERS ID 1115752



Case Details

VAERS ID: 1115752 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-02-06
Onset:2021-03-15
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Abortion spontaneous, Blood test abnormal, Exposure during pregnancy, Human chorionic gonadotropin decreased, Pregnancy test positive, Vaginal haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow), Fertility disorders (narrow)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: omeprazole, prenatal vitamin, zyrtec
Current Illness:
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pregnancy occurred within the 8 days following the vaccine. Pregnancy confirmed with positive urine pregnancy test on 03/01/2021. Some vaginal bleeding began 03/12/2021 but resolved quickly. Abdominal cramping and bleeding on 03/15/2021 and 03/16/2021. Blood work completed on 03/15/2021 and 03/17/2021 showed a decrease in pregnancy hormone and pregnancy was considered miscarried.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1115752


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