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From the 11/19/2021 release of VAERS data:

This is VAERS ID 967169

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Case Details

VAERS ID: 967169 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-16
Onset:2021-01-21
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Blood test, Exposure during pregnancy, Ultrasound scan, Urine analysis
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: N/A
Diagnostic Lab Data: Blood, urine, and ultrasound on 1/21/2021
CDC Split Type:

Write-up: Miscarriage? around 7 weeks pregnant at the time of vaccine, estimated delivery date was 8/19/2021


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