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From the 5/7/2021 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 1002168

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Case Details

VAERS ID: 1002168 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-01-10
Onset:2021-02-02
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Foetal heart rate abnormal, Ultrasound antenatal screen abnormal, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Magnesium, vit d, prenatal vitamin, vit c
Current Illness: None
Preexisting Conditions: PCOS, high cholesterol
Allergies: None
Diagnostic Lab Data: 2/2/2021- in office transabdominal umtrasound, revealed no fetal heart beat . Scheduled d&c/s 2/5/2021
CDC Split Type:

Write-up: 2nd pregnancy, at date of first dose (1/10/2021), 12 weeks 3 days gestation. on 2/2/2021 patient developed light vaginal bleeding. Ultrasound exam revealed no fetal heartbeat. Measurements showed gestational size 14 weeks 1 day (1/22/2021).


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